Healthcare Provider Details

I. General information

NPI: 1003132598
Provider Name (Legal Business Name): JOHN J GREZULA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 209 AND BOSSARDSVILLE RD.
SCIOTA PA
18354
US

IV. Provider business mailing address

RTE 209 BOSSARDSVILLE RD BOSSARDSVILLE RD
SCIOTA PA
18354
US

V. Phone/Fax

Practice location:
  • Phone: 570-992-6300
  • Fax:
Mailing address:
  • Phone: 570-992-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP034703L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberRP034703L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP034703L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: