Organization
GREENBRIER MEDICAL ARTS PHARMACY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID ALLEN CARSON (PRESIDENT)
(304) 645-5547
Entity
Organization
Contact information
Practice address
3558 JEFFERSON ST N STE 1, LEWISBURG, WV 24901-5730
(304) 647-1377
(304) 647-9772
Mailing address
3558 JEFFERSON ST N STE 1, LEWISBURG, WV 24901-5730
(304) 645-5547
(304) 645-5549
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
MP0552303
WV
3336C0003X
Community/Retail Pharmacy
Primary
MP0552323
WV
3336L0003X
Long Term Care Pharmacy
MP0552323
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0141908001
—
WV
05
—
1912900614
—
VA
01
—
5012098
NCPDP NUMBER
WV
01
—
Q446250001
PALMETTO GBA PTAN
WV
Enumeration date
05/27/2005
Last updated
02/09/2022
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