Healthcare Provider Details

I. General information

NPI: 1700987294
Provider Name (Legal Business Name): GREENBRIER PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2354 HIGHWAY 41 S
GREENBRIER TN
37073-5510
US

IV. Provider business mailing address

2354 HIGHWAY 41 S
GREENBRIER TN
37073-5510
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0000004255
License Number StateTN

VIII. Authorized Official

Name: MISTY WILLIAMSON
Title or Position: OWNER/PIC
Credential: PHARM D
Phone: 615-643-6979