=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194169615
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREYSTONE VILLAGE PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2013
-----------------------------------------------------
Last Update Date | 03/20/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7713 LEAD MINE RD STE 37
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27615-4805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-844-7939
-----------------------------------------------------
Fax | 919-844-7903
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 SPRINGBUD DR
-----------------------------------------------------
City | CARY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-844-7939
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HARRY MCGAUGHEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-844-7939
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 11614
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------