MEDICARE: GREENBRIER MEDICAL ARTS PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	SP0552441	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2138032	OTHER		PK

General Provider Information

NPI Number	:	1750444360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENBRIER MEDICAL ARTS PHARMACY INC

Provider Business Mailing Address
First Line	:	3558 JEFFERSON ST N STE 1
Second Line	:
City	:	LEWISBURG
State	:	WV
Zip	:	24901-5730
Country	:	US
Telephone Number	:	304-645-5547
Fax Number	:	304-645-5549

Provider Business Practice Location Address
First Line	:	128 COMMUNITY LN
Second Line	:
City	:	WHITE SULPHUR SPRINGS
State	:	WV
Zip	:	24986-1105
Country	:	US
Telephone Number	:	304-536-2454
Fax Number	:	304-536-1335

Authorized Official
Title or Position	:	CORPORATE OFFICE MANAGER
Name	:	ERIN HAGER
Credential	:
Telephone Number	:	304-793-3981

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	03/15/2017

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