Provider Demographics
NPI:1366868911
Name:GREENWOOD HEALTHCARE LLC
Entity Type:Organization
Organization Name:GREENWOOD HEALTHCARE LLC
Other - Org Name:GREENWOOD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:407-915-6505
Mailing Address - Street 1:3801 W LAKE MARY BLVD UNIT 127
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6168
Mailing Address - Country:US
Mailing Address - Phone:407-915-6505
Mailing Address - Fax:
Practice Address - Street 1:3801 W LAKE MARY BLVD UNIT 127
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6168
Practice Address - Country:US
Practice Address - Phone:407-915-6505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-06
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH27610333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy