MEDICARE: ALYSHA M GREEN

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	0202221531	VA

General Provider Information

NPI Number	:	1447036959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSHA M GREEN

Provider Business Mailing Address
First Line	:	918 SPARROW CT
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23608-2225
Country	:	US
Telephone Number	:	903-559-5238
Fax Number	:

Provider Business Practice Location Address
First Line	:	7529 RICHMOND RD
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-7226
Country	:	US
Telephone Number	:	757-259-7892
Fax Number	:

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

Provider Enumeration Date	:	08/31/2023
Last Update Date	:	08/31/2023

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Directions to “ ALYSHA M GREEN ” Practice Location

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