=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114343480
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREENBRIAR PHARMACY LP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2014
-----------------------------------------------------
Last Update Date | 03/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 FM 2449
-----------------------------------------------------
City | PONDER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-479-0111
-----------------------------------------------------
Fax | 940-479-0711
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 250 FM 2449
-----------------------------------------------------
City | PONDER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-479-0111
-----------------------------------------------------
Fax | 940-479-0711
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHARMACIST
-----------------------------------------------------
Name | MR. ROBERT FRANCIS DOWDEN
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 940-479-0111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------