=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003374331
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNA LYNNE MCGREEVY PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2019
-----------------------------------------------------
Last Update Date | 03/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 RIDGE ST
-----------------------------------------------------
City | GLENS FALLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12801-3624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-798-6066
-----------------------------------------------------
Fax | 518-761-2097
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 DEER RUN DR
-----------------------------------------------------
City | BALLSTON SPA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12020-4608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-524-0046
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 063019
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------