Provider Demographics
NPI:1336744788
Name:GREENWOOD, CARRIE
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6760 CARDIFF CT
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2755
Mailing Address - Country:US
Mailing Address - Phone:515-971-6861
Mailing Address - Fax:
Practice Address - Street 1:2303 MERLE HAY RD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-1140
Practice Address - Country:US
Practice Address - Phone:515-255-5233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist