Provider Demographics
NPI:1649502709
Name:GREENWALL PHARMACY & DISCOUNT ,INC
Entity type:Organization
Organization Name:GREENWALL PHARMACY & DISCOUNT ,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:OLGA
Authorized Official - Last Name:TEIJEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-448-4388
Mailing Address - Street 1:3390 SW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2236
Mailing Address - Country:US
Mailing Address - Phone:305-448-4388
Mailing Address - Fax:305-448-4390
Practice Address - Street 1:3390 SW 22ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2236
Practice Address - Country:US
Practice Address - Phone:305-448-4388
Practice Address - Fax:305-448-4390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-31
Last Update Date:2010-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH244281835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapyGroup - Single Specialty