Healthcare Provider Details

I. General information

NPI: 1811084056
Provider Name (Legal Business Name): GREENWOOD DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
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 TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number334
License Number StateIA

VIII. Authorized Official

Name: JOSEPH PATRICK GREENWOOD
Title or Position: PRESIDENT/PIC
Credential: PHARM.D
Phone: 319-236-8067