Provider Demographics
NPI:1538143227
Name:GREENFIELD PHARMACY INC
Entity Type:Organization
Organization Name:GREENFIELD PHARMACY INC
Other - Org Name:GREENFIELD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEENTS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:417-637-2909
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65661-0158
Mailing Address - Country:US
Mailing Address - Phone:417-637-2909
Mailing Address - Fax:417-637-6521
Practice Address - Street 1:105 N GRAND ST
Practice Address - Street 2:STE 1
Practice Address - City:GREENFIELD
Practice Address - State:MO
Practice Address - Zip Code:65661-8198
Practice Address - Country:US
Practice Address - Phone:417-637-2909
Practice Address - Fax:417-637-5621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
MOPS0046793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO621294503Medicaid
MO601294507Medicaid
2050060OtherPK
0189530001Medicare NSC
MO601294507Medicaid
MO000008898Medicare PIN