NPIMap

Individual provider Active NPI

Derrick Greenwell

  • Pharmacist
  • Louisville, KY
National Provider Identifier
1295016509
Registry record updated Aug 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
012887 Issued in KY
Practice address
11930 Standiford Plaza Dr
Louisville, KY 40229-5901
Phone
(502) 961-5843
Fax
(502) 961-5847
NPI assigned
Aug 31, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 31, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 012887 KY Primary

Addresses

Primary practice location

11930 Standiford Plaza Dr
Louisville, KY 40229-5901

Mailing address

123 Creekside Dr
Coxs Creek, KY 40013-6617

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
012887KYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co Past Accepting new patients
C & G Pharmacy LLC. Past Accepting new patients
Walgreen Co Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1314748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314748800000",
    "number": "1295016509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 CREEKSIDE DR",
            "city": "COXS CREEK",
            "state": "KY",
            "postal_code": "400136617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11930 STANDIFORD PLAZA DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402295901",
            "telephone_number": "502-961-5843",
            "fax_number": "502-961-5847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENWELL",
        "first_name": "DERRICK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-31",
        "last_updated": "2011-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "KY",
            "license": "012887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.