Provider Demographics
NPI:1861760803
Name:CHANDLER, GREGORY SCOTT (RPH)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:SCOTT
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2624 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-3747
Mailing Address - Country:US
Mailing Address - Phone:252-937-4999
Mailing Address - Fax:252-937-8396
Practice Address - Street 1:2624 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3747
Practice Address - Country:US
Practice Address - Phone:252-937-4999
Practice Address - Fax:252-937-8396
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12559183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist