Provider Demographics
NPI:1447079603
Name:GREENFIELD NINE PHARMACY LLC
Entity type:Organization
Organization Name:GREENFIELD NINE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY RELATIONSHIP MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARMESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-663-3379
Mailing Address - Street 1:15627 W 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3718
Mailing Address - Country:US
Mailing Address - Phone:248-809-6024
Mailing Address - Fax:248-809-6045
Practice Address - Street 1:15627 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3718
Practice Address - Country:US
Practice Address - Phone:248-809-6024
Practice Address - Fax:248-809-6045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-05
Last Update Date:2024-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy