Healthcare Provider Details

I. General information

NPI: 1528137015
Provider Name (Legal Business Name): GREENVILLE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 CORRECTIONVILLE RD
SIOUX CITY IA
51105-3627
US

IV. Provider business mailing address

2701 CORRECTIONVILLE RD
SIOUX CITY IA
51105-3627
US

V. Phone/Fax

Practice location:
  • Phone: 712-258-0113
  • Fax: 712-258-0351
Mailing address:
  • Phone: 712-258-0113
  • Fax: 712-258-0351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number667
License Number StateIA

VIII. Authorized Official

Name: MR. ROBERT P REHAL
Title or Position: VP
Credential: PHARMACIST
Phone: 712-258-0113