Provider Demographics
NPI:1902903206
Name:HUENERGARDT, GREGORY SCOTT (DPH)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:SCOTT
Last Name:HUENERGARDT
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W. JANE JAYROE
Mailing Address - Street 2:
Mailing Address - City:LAVERNE
Mailing Address - State:OK
Mailing Address - Zip Code:73848-1250
Mailing Address - Country:US
Mailing Address - Phone:580-921-3373
Mailing Address - Fax:580-921-5469
Practice Address - Street 1:102 W. JANE JAYROE
Practice Address - Street 2:
Practice Address - City:LAVERNE
Practice Address - State:OK
Practice Address - Zip Code:73848-1250
Practice Address - Country:US
Practice Address - Phone:580-921-3373
Practice Address - Fax:580-921-5469
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11624183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist