Healthcare Provider Details

I. General information

NPI: 1063666170
Provider Name (Legal Business Name): GREGGORY MILK R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 W MAIN ST
HANCOCK NY
13783-1017
US

IV. Provider business mailing address

119 W MAIN ST
HANCOCK NY
13783-1017
US

V. Phone/Fax

Practice location:
  • Phone: 607-637-2887
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number32637
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: