MEDICARE: GREENHAVEN PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	PHY51814	CA

General Provider Information

NPI Number	:	1528484631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENHAVEN PHARMACY

Provider Business Mailing Address
First Line	:	7248 S LAND PARK DR STE 116
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95831-3661
Country	:	US
Telephone Number	:	916-378-5757
Fax Number	:	916-290-6639

Provider Business Practice Location Address
First Line	:	7248 S LAND PARK DR STE 116
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95831-3661
Country	:	US
Telephone Number	:	916-378-5757
Fax Number	:	916-290-6639

Authorized Official
Title or Position	:	MANAGER
Name	:	EDDY C PON
Credential	:	RPH
Telephone Number	:	916-290-6639

Provider Enumeration Date	:	03/13/2014
Last Update Date	:	03/13/2014

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Directions to “GREENHAVEN PHARMACY ” Practice Location

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