Provider Demographics
NPI:1033790878
Name:GREESON RX
Entity Type:Organization
Organization Name:GREESON RX
Other - Org Name:POOLER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:ZANE
Authorized Official - Last Name:GREESON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:912-348-4200
Mailing Address - Street 1:1779 ALDERMAN RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLET
Mailing Address - State:GA
Mailing Address - Zip Code:30415-8236
Mailing Address - Country:US
Mailing Address - Phone:912-687-2040
Mailing Address - Fax:
Practice Address - Street 1:1557 POOLER PKWY STE 400
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4389
Practice Address - Country:US
Practice Address - Phone:912-348-4200
Practice Address - Fax:912-348-4421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-14
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHRE010929OtherPHARMACY LICENSE
GA003253912AMedicaid