Provider Demographics
NPI:1679887772
Name:GREENWICH PHARMACY LLC
Entity type:Organization
Organization Name:GREENWICH PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DMITRI
Authorized Official - Middle Name:
Authorized Official - Last Name:DANAIROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-661-2721
Mailing Address - Street 1:11045 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2936
Mailing Address - Country:US
Mailing Address - Phone:917-559-3632
Mailing Address - Fax:
Practice Address - Street 1:116 GREENWICH AVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5504
Practice Address - Country:US
Practice Address - Phone:203-661-2721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0722048OtherNCPDP PROVIDER IDENTIFICATION NUMBER