Provider Demographics
NPI:1891387551
Name:GREENFIELD PHARMS, LLC
Entity Type:Organization
Organization Name:GREENFIELD PHARMS, LLC
Other - Org Name:DUNCAN'S PHARMACY OF GREENFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TOBY
Authorized Official - Middle Name:DEREK
Authorized Official - Last Name:HOLYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:731-618-1787
Mailing Address - Street 1:1751 S MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:38230-1827
Mailing Address - Country:US
Mailing Address - Phone:731-681-5678
Mailing Address - Fax:731-681-5679
Practice Address - Street 1:1751 S MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:TN
Practice Address - Zip Code:38230-1827
Practice Address - Country:US
Practice Address - Phone:731-681-5678
Practice Address - Fax:731-681-5679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6991OtherSTATE PHARMACY LICENSE
TNQ064144Medicaid