Provider Demographics
NPI:1003071622
Name:GREENHAW PHARMACY
Entity Type:Organization
Organization Name:GREENHAW PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-947-3784
Mailing Address - Street 1:508 S ASH ST
Mailing Address - Street 2:PO BOX 188
Mailing Address - City:HILLSBORO
Mailing Address - State:KS
Mailing Address - Zip Code:67063-1559
Mailing Address - Country:US
Mailing Address - Phone:620-947-3784
Mailing Address - Fax:620-947-2801
Practice Address - Street 1:508 S ASH ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:KS
Practice Address - Zip Code:67063-1559
Practice Address - Country:US
Practice Address - Phone:620-947-3784
Practice Address - Fax:620-947-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13638332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100441080AMedicaid
KS200406440BMedicaid
KS100441080BMedicaid
KS200406440AMedicaid
KS200406440AMedicaid