Provider Demographics
NPI:1992704183
Name:GRETNA DRUG CO., INC.
Entity type:Organization
Organization Name:GRETNA DRUG CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:CHAPMAN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:434-656-1251
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:VA
Mailing Address - Zip Code:24557-0456
Mailing Address - Country:US
Mailing Address - Phone:434-656-1251
Mailing Address - Fax:434-656-6003
Practice Address - Street 1:108 VADEN DR
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:VA
Practice Address - Zip Code:24557-4160
Practice Address - Country:US
Practice Address - Phone:434-656-1251
Practice Address - Fax:434-656-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BX2000X
VA0201000332333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008501815Medicaid
VA009148523Medicaid
VA009148523Medicaid
VA870699852Medicare PIN