Provider Demographics
NPI:1811455827
Name:GREENVILLE PHARMACY INC
Entity type:Organization
Organization Name:GREENVILLE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RPH
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:REHAL
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:712-258-0113
Mailing Address - Street 1:2701 CORRECTIONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51105-3627
Mailing Address - Country:US
Mailing Address - Phone:712-258-0113
Mailing Address - Fax:712-258-0351
Practice Address - Street 1:2701 CORRECTIONVILLE RD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51105-3627
Practice Address - Country:US
Practice Address - Phone:712-258-0113
Practice Address - Fax:712-258-0351
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENVILLE PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy