1255641718 NPI number — MR. GREGORY SAMUEL LULA RPH

Table of content: MR. GREGORY SAMUEL LULA RPH (NPI 1255641718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255641718 NPI number — MR. GREGORY SAMUEL LULA RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LULA
Provider First Name:
GREGORY
Provider Middle Name:
SAMUEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255641718
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 E MORGAN CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILTON HEAD ISLAND
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29926-2052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-304-1666
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
721 N OKATIE HWY # 170
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGELAND
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29936-8276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-304-1666
Provider Business Practice Location Address Fax Number:
843-987-0023
Provider Enumeration Date:
10/18/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  49203 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 26013139A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: PCT0005692 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 17522 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 9775 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: RPH021123 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)