MEDICARE: GREENBRIER MEDICAL ARTS PHARMACY, INC

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy	MP0552303	WV
3	3336L0003X	Long Term Care Pharmacy	MP0552323	WV
4	3336C0003X	Community/Retail Pharmacy	MP0552323	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Q446250001	OTHER	WV	PALMETTO GBA PTAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5012098	OTHER	WV	NCPDP NUMBER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912900614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENBRIER MEDICAL ARTS PHARMACY, INC

Provider Business Mailing Address
First Line	:	3558 JEFFERSON ST N STE 1
Second Line	:
City	:	LEWISBURG
State	:	WV
Zip	:	24901-5730
Country	:	US
Telephone Number	:	304-645-5547
Fax Number	:	304-645-5549

Provider Business Practice Location Address
First Line	:	3558 JEFFERSON ST N STE 1
Second Line	:
City	:	LEWISBURG
State	:	WV
Zip	:	24901-5730
Country	:	US
Telephone Number	:	304-647-1377
Fax Number	:	304-647-9772

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID ALLEN CARSON
Credential	:
Telephone Number	:	304-645-5547

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	02/09/2022

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Directions to “GREENBRIER MEDICAL ARTS PHARMACY, INC ” Practice Location

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