=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699694133
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REVIVAL PHARMS WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2026
-----------------------------------------------------
Last Update Date | 07/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 603 HIGHWAY 6 STE 3
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68003-2155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-454-9750
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 603 HIGHWAY 6 STE 3
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68003-2155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | DR. JEANNE GREISEN
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 817-454-9750
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835N1003X
-----------------------------------------------------
Taxonomy Name | Nutrition Support Pharmacist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------