Provider Demographics
NPI:1700987294
Name:GREENBRIER PHARMACY LLC
Entity Type:Organization
Organization Name:GREENBRIER PHARMACY LLC
Other - Org Name:GREENBRIER PHARMACY AND FOUNTAIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:615-643-6979
Mailing Address - Street 1:2354 HIGHWAY 41 S
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:TN
Mailing Address - Zip Code:37073-5510
Mailing Address - Country:US
Mailing Address - Phone:615-643-6979
Mailing Address - Fax:
Practice Address - Street 1:2354 HIGHWAY 41 S
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:TN
Practice Address - Zip Code:37073-5510
Practice Address - Country:US
Practice Address - Phone:615-643-6979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000042553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNBG9638137OtherDEA