Healthcare Provider Details

I. General information

NPI: 1447699871
Provider Name (Legal Business Name): GREENHILL PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2531 WOODRUFF RD STE 107
SIMPSONVILLE SC
29681-5465
US

IV. Provider business mailing address

2531 WOODRUFF RD SUITE 107
SIMPSONVILLE SC
29681-5465
US

V. Phone/Fax

Practice location:
  • Phone: 864-520-1550
  • Fax: 864-520-1505
Mailing address:
  • Phone: 864-520-1550
  • Fax: 864-520-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number14664
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TOMMY MARTINCIC
Title or Position: PRESIDENT
Credential:
Phone: 864-520-1550