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General NPI Number Information
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NPI Number | 1215288626
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Entity Type | Organization
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Legal Business Name | GREENTREE PHARMACY LLC
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Dates
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Enumeration Date | 09/25/2012
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Last Update Date | 03/13/2013
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Provider Practice Location Address
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Address Line | 301 S KIRKWOOD RD
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City | KIRKWOOD
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State | MO
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Zip | 63122-6117
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Country | US
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Telephone | 314-394-2404
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Fax | 314-394-2120
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Provider Business Mailing Address
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Address Line | 301 S KIRKWOOD RD
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City | KIRKWOOD
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State | MO
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Zip | 63122-6117
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Country | US
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Telephone | 314-394-2404
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Fax | 314-394-2120
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. PAUL MATTHEW HUESEMAN
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Credential | PHARMD
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Telephone | 314-394-2404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | MO
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