Provider Demographics
NPI:1609949007
Name:GREENE VALLEY DEVELOPMENTAL CENTER PHARMACY
Entity Type:Organization
Organization Name:GREENE VALLEY DEVELOPMENTAL CENTER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:CROCKETT
Authorized Official - Last Name:MEECE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:423-787-6568
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37744-0910
Mailing Address - Country:US
Mailing Address - Phone:423-378-7665
Mailing Address - Fax:423-787-6776
Practice Address - Street 1:4850 E ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-3098
Practice Address - Country:US
Practice Address - Phone:423-378-7665
Practice Address - Fax:423-787-6776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN711320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
4416067OtherNABP