Provider Demographics
NPI:1841611902
Name:GREYWELL PHARMACY INC
Entity Type:Organization
Organization Name:GREYWELL PHARMACY INC
Other - Org Name:GREYWELL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:LVOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:818-306-5500
Mailing Address - Street 1:10672 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2319
Mailing Address - Country:US
Mailing Address - Phone:818-306-5500
Mailing Address - Fax:818-287-0999
Practice Address - Street 1:10672 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-2319
Practice Address - Country:US
Practice Address - Phone:818-306-5500
Practice Address - Fax:818-287-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY58650OtherBOARD OF PHARMACY
CA56-49910OtherNCPDP PROVIDER NUMBER