Healthcare Provider Details

I. General information

NPI: 1164726014
Provider Name (Legal Business Name): GREENE VILLAGE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 ROUTE 202
GREENE ME
04236-4242
US

IV. Provider business mailing address

526 ROUTE 202
GREENE ME
04236-4242
US

V. Phone/Fax

Practice location:
  • Phone: 207-946-2425
  • Fax: 207-946-2428
Mailing address:
  • Phone: 207-946-2425
  • Fax: 207-946-2428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH50001422
License Number StateME

VIII. Authorized Official

Name: MS. JACQUELINE ANN SCHOMAKER
Title or Position: VICE PRESIDENT
Credential: RPH
Phone: 207-754-1128