Provider Demographics
NPI: | 1720543812 |
---|---|
Name: | GREENFIELD PHARMACY LLC |
Entity Type: | Organization |
Organization Name: | GREENFIELD PHARMACY LLC |
Other - Org Name: | NUCARA PHARMACY #100 |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | ACQUISITIONS MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LORI |
Authorized Official - Middle Name: | ANN |
Authorized Official - Last Name: | WILLIS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 641-366-3440 |
Mailing Address - Street 1: | PO BOX 640 |
Mailing Address - Street 2: | |
Mailing Address - City: | CONRAD |
Mailing Address - State: | IA |
Mailing Address - Zip Code: | 50621-0640 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 641-366-3440 |
Mailing Address - Fax: | 641-366-3442 |
Practice Address - Street 1: | 202 SE KENT ST STE 1 |
Practice Address - Street 2: | |
Practice Address - City: | GREENFIELD |
Practice Address - State: | IA |
Practice Address - Zip Code: | 50849-1411 |
Practice Address - Country: | US |
Practice Address - Phone: | 641-343-7015 |
Practice Address - Fax: | 641-743-6343 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-02-04 |
Last Update Date: | 2020-11-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |
No | 3336L0003X | Suppliers | Pharmacy | Long Term Care Pharmacy |