Organization
GREEN WAVE PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHERYL DAWN PIENTKA RPH (PHARMACIST IN CHARGE)
(276) 926-4733
Entity
Organization
Contact information
Practice address
165 MCCLURE AVE, CLINTWOOD, VA 24228-6845
(276) 926-4733
(276) 926-5137
Mailing address
165 MCCLURE AVE, PO BOX 1310, CLINTWOOD, VA 24228-6845
(276) 926-4733
(276) 926-5137
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
0201002056
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008514186
—
VA
01
—
4818398
NABP
—
Enumeration date
06/01/2006
Last updated
08/05/2008
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