Provider Demographics
NPI:1003060047
Name:GREENWOOD DOWNTOWN DRUGS INC
Entity Type:Organization
Organization Name:GREENWOOD DOWNTOWN DRUGS INC
Other - Org Name:GREENWOOD DOWNTOWN DRUGS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-887-4135
Mailing Address - Street 1:105 CARROLLTON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-4436
Mailing Address - Country:US
Mailing Address - Phone:662-453-4401
Mailing Address - Fax:662-453-2527
Practice Address - Street 1:105 CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-4436
Practice Address - Country:US
Practice Address - Phone:662-453-4401
Practice Address - Fax:662-453-2527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MS11389/1.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135379OtherPK