Active NPI
Derrick Greenwell
- Pharmacist
- Louisville, KY
National Provider Identifier
1295016509
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 012887
- Practice address
- 11930 Standiford Plaza Dr
Louisville, KY 40229-5901 - Phone
- (502) 961-5843
- Fax
- (502) 961-5847
- NPI assigned
- Aug 31, 2011
- Last updated
- Aug 31, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| 012887 | KY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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.