Healthcare Provider Details

I. General information

NPI: 1235042169
Provider Name (Legal Business Name): GREGG CHARLES JUGLA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 SPRUCE ST
PHILADELPHIA PA
19107-5701
US

IV. Provider business mailing address

858 N 29TH ST
PHILADELPHIA PA
19130-1144
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-5451
  • Fax:
Mailing address:
  • Phone: 215-829-5451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP039380L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: