Provider Demographics
NPI:1538406483
Name:PRESTI, GREGORY STEPHEN
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:STEPHEN
Last Name:PRESTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SE 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-6949
Mailing Address - Country:US
Mailing Address - Phone:561-292-2085
Mailing Address - Fax:561-248-0278
Practice Address - Street 1:501 SE 18TH AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-6949
Practice Address - Country:US
Practice Address - Phone:561-292-2085
Practice Address - Fax:561-248-0278
Is Sole Proprietor?:No
Enumeration Date:2013-01-12
Last Update Date:2013-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS21187183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist