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General NPI Number Information
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NPI Number | 1174509939
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Entity Type | Organization
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Legal Business Name | GREENVILLE DRUG STORE INC
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 213 CENTRAL AVE
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City | NORWICH
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State | CT
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Zip | 06360-3801
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Country | US
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Telephone | 860-889-9857
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Fax | 860-886-0950
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Provider Business Mailing Address
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Address Line | 213 CENTRAL AVE
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City | NORWICH
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State | CT
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Zip | 06360-3801
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Country | US
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Telephone | 860-889-9857
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Fax | 860-886-0950
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN A KISZKIEL II
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Credential | RPH
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Telephone | 860-889-9857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 731
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License Number State | CT
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