Provider Demographics
NPI:1396949558
Name:GREENVILLE PHARMACY INC.
Entity type:Organization
Organization Name:GREENVILLE PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BONFIGLIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-548-4515
Mailing Address - Street 1:530 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-1927
Mailing Address - Country:US
Mailing Address - Phone:937-548-2424
Mailing Address - Fax:
Practice Address - Street 1:530 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1927
Practice Address - Country:US
Practice Address - Phone:937-548-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02063330005585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty