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General NPI Number Information
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NPI Number | 1972972529
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Entity Type | Organization
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Legal Business Name | GREYSTONE RX
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Dates
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Enumeration Date | 09/24/2015
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Last Update Date | 01/11/2016
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Provider Practice Location Address
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Address Line | 15361 HIGHWAY 5 APT F
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City | CABOT
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State | AR
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Zip | 72023-5144
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Country | US
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Telephone | 501-286-6054
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Fax | 501-286-6056
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Provider Business Mailing Address
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Address Line | 15361 HIGHWAY 5 APT F
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City | CABOT
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State | AR
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Zip | 72023-5144
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Country | US
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Telephone | 501-286-6054
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Fax | 501-286-6056
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Authorized Official
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Title or Position | OWNER/PIC
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Name | TRENTON SHIPLEY
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Credential | PD
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Telephone | 501-286-6054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | AR20814
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License Number State | AR
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