Provider Demographics
NPI:1871212720
Name:GREENVILLE DRUG STORE INC
Entity type:Organization
Organization Name:GREENVILLE DRUG STORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STORE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCRONCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-889-9857
Mailing Address - Street 1:213 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-3801
Mailing Address - Country:US
Mailing Address - Phone:860-889-9857
Mailing Address - Fax:860-886-0950
Practice Address - Street 1:213 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-3801
Practice Address - Country:US
Practice Address - Phone:860-889-9857
Practice Address - Fax:860-886-0950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy