Healthcare Provider Details

I. General information

NPI: 1932642600
Provider Name (Legal Business Name): GREENWOOD DRUG, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
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 STE B
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: 319-274-9064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1635
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT JOHN GREENWOOD
Title or Position: PIC/OWNER
Credential: BS PHARMACY
Phone: 319-234-6673