Provider Demographics
NPI:1912539818
Name:GREENVILLE PHARMACY LLC
Entity Type:Organization
Organization Name:GREENVILLE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VENKATA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAJETI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:405-361-5420
Mailing Address - Street 1:4209 WESLEY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-5637
Mailing Address - Country:US
Mailing Address - Phone:903-213-2258
Mailing Address - Fax:903-461-7591
Practice Address - Street 1:4209 WESLEY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-5637
Practice Address - Country:US
Practice Address - Phone:903-213-2258
Practice Address - Fax:903-461-7591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-08
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy