Healthcare Provider Details

I. General information

NPI: 1003341033
Provider Name (Legal Business Name): GREGORY KINGSBURY II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5965 HOOVER RD
GROVE CITY OH
43123-9702
US

IV. Provider business mailing address

5965 HOOVER RD
GROVE CITY OH
43123-9702
US

V. Phone/Fax

Practice location:
  • Phone: 614-277-3405
  • Fax:
Mailing address:
  • Phone: 614-277-3405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03321550
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: