Provider Demographics
NPI:1902841430
Name:GREENFIELD ENTERPRISES INC
Entity Type:Organization
Organization Name:GREENFIELD ENTERPRISES INC
Other - Org Name:GARY DRUG COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:617-227-0023
Mailing Address - Street 1:59 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-4605
Mailing Address - Country:US
Mailing Address - Phone:617-227-0023
Mailing Address - Fax:617-227-2879
Practice Address - Street 1:59 CHARLES ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-4605
Practice Address - Country:US
Practice Address - Phone:617-227-0023
Practice Address - Fax:617-227-2879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MADS39373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0405892Medicaid
2038591OtherPK