Provider Demographics
NPI:1447699871
Name:GREENHILL PHARMACY INC
Entity type:Organization
Organization Name:GREENHILL PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINCIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-520-1550
Mailing Address - Street 1:2531 WOODRUFF RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-5465
Mailing Address - Country:US
Mailing Address - Phone:864-520-1550
Mailing Address - Fax:864-520-1505
Practice Address - Street 1:2531 WOODRUFF RD STE 107
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-5465
Practice Address - Country:US
Practice Address - Phone:864-520-1550
Practice Address - Fax:864-520-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
SC146643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140829OtherPK
SC7226150001Medicare NSC