Mark Damian Greenwell
Individual provider Active NPI Pharmacist · Benson, NC
NPI 1770871014 · NPPES record last updated Jul 20, 2011
Key facts
- NPI
- 1770871014
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 10478 (NC)
- Practice address
- 13440 NC 210 Highway
Benson, NC 27504 - Phone
- (919) 207-3086
- NPI assigned
- Jul 20, 2011
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10478 | NC | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 10478 | NC | Yes |
Addresses
Primary practice location
13440 NC 210 Highway
Benson, NC 27504
Mailing address
40 Terrace Ridge Dr
Angier, NC 27501-9135
Phone (919) 276-4037
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| BN9778171 | Medicaid | NC |
Other providers in Benson, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.