Provider Demographics
NPI:1801005236
Name:GREENWOOD, DEBRA K (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:K
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:938 2ND AVE W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-3916
Mailing Address - Country:US
Mailing Address - Phone:701-483-4401
Mailing Address - Fax:701-456-6101
Practice Address - Street 1:938 2ND AVE W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-3916
Practice Address - Country:US
Practice Address - Phone:701-483-4401
Practice Address - Fax:701-456-6101
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDGRE521406OtherDRIVERS LICENSE