Healthcare Provider Details

I. General information

NPI: 1083772115
Provider Name (Legal Business Name): GREEVERS DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 12/02/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 E LEE HWY
CHILHOWIE VA
24319
US

IV. Provider business mailing address

PO BOX 556
CHILHOWIE VA
24319-0556
US

V. Phone/Fax

Practice location:
  • Phone: 276-646-3512
  • Fax: 276-646-2342
Mailing address:
  • Phone: 276-646-3512
  • Fax: 276-646-2342

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 Number0201001127
License Number StateVA

VIII. Authorized Official

Name: BRENT FOSTER
Title or Position: OWNER
Credential: BS PHARMACY
Phone: 276-646-3512