Provider Demographics
NPI:1659399392
Name:GREENWELL'S PHARMACY
Entity Type:Organization
Organization Name:GREENWELL'S PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:I
Authorized Official - Last Name:GREENWELL
Authorized Official - Suffix:III
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-564-6943
Mailing Address - Street 1:233 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-1129
Mailing Address - Country:US
Mailing Address - Phone:606-564-6943
Mailing Address - Fax:606-564-6943
Practice Address - Street 1:233 MARKET ST
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-1129
Practice Address - Country:US
Practice Address - Phone:606-564-6943
Practice Address - Fax:606-564-6943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY P00104332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9006081500Medicaid
KY54012752Medicaid