Provider Demographics
NPI:1043674518
Name:GREENBUSCH PHARMACY INC
Entity Type:Organization
Organization Name:GREENBUSCH PHARMACY INC
Other - Org Name:GREENBUSCH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER, PIC
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KONHAWA-KAMDEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-437-1130
Mailing Address - Street 1:25757 WESTHEIMER PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7669
Mailing Address - Country:US
Mailing Address - Phone:832-437-1130
Mailing Address - Fax:832-437-3968
Practice Address - Street 1:26717 WESTHEIMER PKWY STE 301
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8058
Practice Address - Country:US
Practice Address - Phone:832-437-1130
Practice Address - Fax:832-201-0839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-11
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
TX307613336C0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159409OtherPK
TX149414Medicaid