Provider Demographics
NPI:1144356502
Name:GREENFIELD PHARMACY INC
Entity type:Organization
Organization Name:GREENFIELD PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:MEENTS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:417-637-2909
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65661-0158
Mailing Address - Country:US
Mailing Address - Phone:417-637-2909
Mailing Address - Fax:417-637-5621
Practice Address - Street 1:105 NORTH GRAND
Practice Address - Street 2:SUITE 1
Practice Address - City:GREENFIELD
Practice Address - State:MO
Practice Address - Zip Code:65661
Practice Address - Country:US
Practice Address - Phone:417-637-2909
Practice Address - Fax:417-637-5621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004679332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO621294503Medicaid
MO0189530001Medicare NSC