Healthcare Provider Details

I. General information

NPI: 1952316580
Provider Name (Legal Business Name): GREENBRIER PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2239 HIGHWAY 41 S STE A
GREENBRIER TN
37073-4536
US

IV. Provider business mailing address

2239 HIGHWAY 41 S STE A GREENBRIER PLAZA
GREENBRIER TN
37073-4536
US

V. Phone/Fax

Practice location:
  • Phone: 615-643-6979
  • Fax: 615-643-6976
Mailing address:
  • Phone: 615-643-6979
  • Fax: 615-643-6976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number4255
License Number StateTN

VIII. Authorized Official

Name: MISTY MCKEE WILLIAMSON
Title or Position: OWNER
Credential: PHARMD
Phone: 615-643-6979