MEDICARE: MRS. KATRICIA GREEN RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03321845	OH

General Provider Information

NPI Number	:	1063795078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATRICIA GREEN RPH

Provider Business Mailing Address
First Line	:	1500 GEMINI PL
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43240-7002
Country	:	US
Telephone Number	:	614-987-1909
Fax Number	:	614-987-1906

Provider Business Practice Location Address
First Line	:	1500 GEMINI PL
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43240-7002
Country	:	US
Telephone Number	:	614-987-1909
Fax Number	:	614-987-1906

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2011
Last Update Date	:	09/26/2011

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