Provider Demographics
NPI:1770873887
Name:GREER, BRENT WESLEY (RPH)
Entity type:Individual
Prefix:MR
First Name:BRENT
Middle Name:WESLEY
Last Name:GREER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3046 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-5252
Mailing Address - Country:US
Mailing Address - Phone:610-636-0598
Mailing Address - Fax:601-636-3378
Practice Address - Street 1:3046 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5252
Practice Address - Country:US
Practice Address - Phone:610-636-0598
Practice Address - Fax:601-636-3378
Is Sole Proprietor?:No
Enumeration Date:2011-04-10
Last Update Date:2011-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-08199183500000X
LA14738183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist