Healthcare Provider Details

I. General information

NPI: 1699694133
Provider Name (Legal Business Name): REVIVAL PHARMS WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 HIGHWAY 6 STE 3
ASHLAND NE
68003-2155
US

IV. Provider business mailing address

603 HIGHWAY 6 STE 3
ASHLAND NE
68003-2155
US

V. Phone/Fax

Practice location:
  • Phone: 817-454-9750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number
License Number State

VIII. Authorized Official

Name: DR. JEANNE GREISEN
Title or Position: PHARMACIST
Credential: RPH
Phone: 817-454-9750