Provider Demographics
NPI:1184895138
Name:GREENFIELD PHARMACY INC
Entity type:Organization
Organization Name:GREENFIELD PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCELMOYL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:831-674-5949
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93927-0305
Mailing Address - Country:US
Mailing Address - Phone:831-674-5949
Mailing Address - Fax:
Practice Address - Street 1:333 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:CA
Practice Address - Zip Code:93927-5131
Practice Address - Country:US
Practice Address - Phone:831-674-5949
Practice Address - Fax:831-674-2955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY515533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA190560Medicaid
2047883OtherPK
2047883OtherPK