Provider Demographics
NPI:1568885929
Name:GREENLEE, DAVID JAMES (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
Last Name:GREENLEE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 GRANT AVE
Mailing Address - Street 2:ROSS PHARMACY
Mailing Address - City:VANDERGRIFT
Mailing Address - State:PA
Mailing Address - Zip Code:15690-1208
Mailing Address - Country:US
Mailing Address - Phone:724-568-1221
Mailing Address - Fax:724-567-7185
Practice Address - Street 1:114 GRANT AVE
Practice Address - Street 2:
Practice Address - City:VANDERGRIFT
Practice Address - State:PA
Practice Address - Zip Code:15690-1208
Practice Address - Country:US
Practice Address - Phone:724-568-1221
Practice Address - Fax:724-567-7185
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030052L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000717104Medicaid
PA0144370001Medicare NSC