Provider Demographics
NPI:1821420746
Name:GREENLEE, TOM WILLIAM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:WILLIAM
Last Name:GREENLEE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CONLEY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6477
Mailing Address - Country:US
Mailing Address - Phone:573-442-7706
Mailing Address - Fax:573-442-8028
Practice Address - Street 1:25 CONLEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6477
Practice Address - Country:US
Practice Address - Phone:573-442-7706
Practice Address - Fax:573-442-8028
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005031045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist