Healthcare Provider Details

I. General information

NPI: 1770533002
Provider Name (Legal Business Name): ROBERT JOHN GREENWOOD RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 KIMBALL AVE
WATERLOO IA
50702-5037
US

IV. Provider business mailing address

2104 KIMBALL AVE
WATERLOO IA
50702-5037
US

V. Phone/Fax

Practice location:
  • Phone: 319-234-6673
  • Fax: 319-226-5898
Mailing address:
  • Phone: 319-234-6673
  • Fax: 319-226-5898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15122
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: