=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912248436
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREENFIELD PHARMS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2013
-----------------------------------------------------
Last Update Date | 04/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2280 N WASHINGTON AVE
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38012-1607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-772-4300
-----------------------------------------------------
Fax | 731-772-0002
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2280 N WASHINGTON AVE
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38012-1607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-772-4300
-----------------------------------------------------
Fax | 731-772-0002
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DEREK HOLYFIELD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 731-618-1787
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 5114
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------