Provider Demographics
NPI:1013664473
Name:PHILIX, GRESHMA MATTATHIL
Entity type:Individual
Prefix:
First Name:GRESHMA
Middle Name:MATTATHIL
Last Name:PHILIX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:673 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1847
Mailing Address - Country:US
Mailing Address - Phone:914-602-5474
Mailing Address - Fax:
Practice Address - Street 1:186 MAIN ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-2317
Practice Address - Country:US
Practice Address - Phone:978-562-5096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH240696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist