Provider Demographics
NPI:1003941626
Name:KRALL, GREGORY R (RPH)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:R
Last Name:KRALL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:GREGORY
Other - Middle Name:R
Other - Last Name:KRALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:810 SAUTTER DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44904-1791
Mailing Address - Country:US
Mailing Address - Phone:419-774-8993
Mailing Address - Fax:
Practice Address - Street 1:875 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1945
Practice Address - Country:US
Practice Address - Phone:419-756-1224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-16776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist