Provider Demographics
NPI:1952316580
Name:GREENBRIER PHARMACY LLC
Entity Type:Organization
Organization Name:GREENBRIER PHARMACY LLC
Other - Org Name:GREENBRIER PHARMACY & FOUNTAIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEE WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:615-643-6979
Mailing Address - Street 1:2239 HIGHWAY 41 S STE A
Mailing Address - Street 2:GREENBRIER PLAZA
Mailing Address - City:GREENBRIER
Mailing Address - State:TN
Mailing Address - Zip Code:37073-4536
Mailing Address - Country:US
Mailing Address - Phone:615-643-6979
Mailing Address - Fax:615-643-6976
Practice Address - Street 1:2239 HIGHWAY 41 S STE A
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:TN
Practice Address - Zip Code:37073-4536
Practice Address - Country:US
Practice Address - Phone:615-643-6979
Practice Address - Fax:615-643-6976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
TN42553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1455238Medicaid
2094990OtherPK
2094990OtherPK
TN1455238Medicaid
5755310001Medicare NSC