NPIMap

Organization Active NPI

Greenbrier Medical Arts Pharmacy, Inc

  • Community/Retail Pharmacy
  • Lewisburg, WV
National Provider Identifier
1912900614
Registry record updated Feb 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
MP0552323 Issued in WV
Legal business name
GREENBRIER MEDICAL ARTS PHARMACY, INC
Practice address
3558 Jefferson St N Ste 1
Lewisburg, WV 24901-5730
Phone
(304) 647-1377
Fax
(304) 647-9772
NPI assigned
May 27, 2005
Last updated
Feb 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2022

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

Authorized official

Name
David Allen Carson
Title
President
Phone
(304) 645-5547

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X MP0552303 WV
Community/Retail Pharmacy 3336C0003X MP0552323 WV Primary
Long Term Care Pharmacy 3336L0003X MP0552323 WV

Addresses

Primary practice location

3558 Jefferson St N Ste 1
Lewisburg, WV 24901-5730

Mailing address

3558 Jefferson St N Ste 1
Lewisburg, WV 24901-5730
Phone (304) 645-5547

Other identifiers 4

IdentifierTypeStateIssuer
5012098OtherWVNCPDP NUMBER
Q446250001OtherWVPALMETTO GBA PTAN
0141908001MedicaidWV
1912900614MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20061017000229 WV Part B Supplier - Mass Immunization (Roster Biller Only) 1759387624 4 other NPIs on this enrollment
Practice locations: Lewisburg, WV; Ronceverte, WV; Union, WV; White Sulphur Springs, WV
O20100930097655 WV DME Supplier - Pharmacy 1759387624 Practice locations: Lewisburg, WV

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

3272 Jefferson St N Ste 1
Ste 1
Lewisburg, WV 24901
Phone (304) 647-1377

NPI Registry JSON

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

{
    "created_epoch": "1117152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644364800000",
    "number": "1912900614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3558 JEFFERSON ST N STE 1",
            "city": "LEWISBURG",
            "state": "WV",
            "postal_code": "249015730",
            "telephone_number": "304-645-5547",
            "fax_number": "304-645-5549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3558 JEFFERSON ST N STE 1",
            "city": "LEWISBURG",
            "state": "WV",
            "postal_code": "249015730",
            "telephone_number": "304-647-1377",
            "fax_number": "304-647-9772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENBRIER MEDICAL ARTS PHARMACY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-27",
        "last_updated": "2022-02-09",
        "certification_date": "2022-02-09",
        "status": "A",
        "authorized_official_last_name": "CARSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-645-5547"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "WV",
            "license": "MP0552303",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WV",
            "license": "MP0552323",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "WV",
            "license": "MP0552323",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "5012098",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA PTAN",
            "identifier": "Q446250001",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0141908001",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1912900614",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewisburg, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.