Provider Demographics
NPI:1912248436
Name:GREENFIELD PHARMS, LLC
Entity Type:Organization
Organization Name:GREENFIELD PHARMS, LLC
Other - Org Name:HOMETOWN DRUG COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-618-1787
Mailing Address - Street 1:2280 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38012-1607
Mailing Address - Country:US
Mailing Address - Phone:731-772-4300
Mailing Address - Fax:731-772-0002
Practice Address - Street 1:2280 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38012-1607
Practice Address - Country:US
Practice Address - Phone:731-772-4300
Practice Address - Fax:731-772-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN51143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ081977Medicaid