Provider Demographics
NPI:1205432895
Name:GRESKO, MAKINDREE NICOLOSI (PHARMD)
Entity type:Individual
Prefix:
First Name:MAKINDREE
Middle Name:NICOLOSI
Last Name:GRESKO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MAKINDREE
Other - Middle Name:ANNE
Other - Last Name:NICOLOSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4840 GLOUCESTER DR
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18902-9535
Mailing Address - Country:US
Mailing Address - Phone:267-824-6684
Mailing Address - Fax:
Practice Address - Street 1:1456 FERRY RD
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2391
Practice Address - Country:US
Practice Address - Phone:215-340-2613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP453181183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist