Provider Demographics
NPI:1841332202
Name:GREENSBORO PHARMACY, INC.
Entity type:Organization
Organization Name:GREENSBORO PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:CLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:410-482-6256
Mailing Address - Street 1:102 S MAIN ST
Mailing Address - Street 2:PO BOX 490
Mailing Address - City:GREENSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21639-0490
Mailing Address - Country:US
Mailing Address - Phone:410-482-6256
Mailing Address - Fax:410-482-2469
Practice Address - Street 1:102 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:MD
Practice Address - Zip Code:21639-0490
Practice Address - Country:US
Practice Address - Phone:410-482-6256
Practice Address - Fax:410-482-2469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP003533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2111045Medicare ID - Type Unspecified