Provider Demographics
NPI:1366457905
Name:GREENWOOD 65 LOW COST RX
Entity Type:Organization
Organization Name:GREENWOOD 65 LOW COST RX
Other - Org Name:LOW COST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-888-5373
Mailing Address - Street 1:988 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1501
Mailing Address - Country:US
Mailing Address - Phone:317-888-5373
Mailing Address - Fax:317-888-0217
Practice Address - Street 1:988 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1501
Practice Address - Country:US
Practice Address - Phone:317-888-5373
Practice Address - Fax:317-888-0217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IN60004200A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2027287OtherPK
IN100378390Medicaid
IN100378390Medicaid
IN0462630001Medicare NSC