Provider Demographics
NPI:1619562022
Name:GREGORY, VICTOR JOSEPH (CPHT)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:JOSEPH
Last Name:GREGORY
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 N LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-6025
Mailing Address - Country:US
Mailing Address - Phone:606-864-4445
Mailing Address - Fax:606-864-1349
Practice Address - Street 1:707 N LAUREL RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-6025
Practice Address - Country:US
Practice Address - Phone:606-864-4445
Practice Address - Fax:606-864-1349
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT00020004183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician