Provider Demographics
NPI:1871548149
Name:WRENCH, GREG
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:WRENCH
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 1:2750 S COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6602
Mailing Address - Country:US
Mailing Address - Phone:303-512-0936
Mailing Address - Fax:303-512-0626
Practice Address - Street 1:2750 S COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6602
Practice Address - Country:US
Practice Address - Phone:303-512-0936
Practice Address - Fax:303-512-0626
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist