Provider Demographics
NPI:1912904178
Name:GREENHOUSE PHARMACY
Entity Type:Organization
Organization Name:GREENHOUSE PHARMACY
Other - Org Name:1668 INVESTMENT AND ASSOCIATION
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:YUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-665-7775
Mailing Address - Street 1:1516 NORIEGA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-4434
Mailing Address - Country:US
Mailing Address - Phone:415-665-7775
Mailing Address - Fax:415-665-7796
Practice Address - Street 1:1516 NORIEGA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-4434
Practice Address - Country:US
Practice Address - Phone:415-665-7775
Practice Address - Fax:415-665-7796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-03
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY37814333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA378140Medicaid
0839890001Medicare NSC