MEDICARE: MATTHEW TYLER GREEN DPH

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	14945	OK

General Provider Information

NPI Number	:	1598353732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW TYLER GREEN DPH

Provider Business Mailing Address
First Line	:	6204 SE 79TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-7006
Country	:	US
Telephone Number	:	405-650-9150
Fax Number	:

Provider Business Practice Location Address
First Line	:	6437 N MACARTHUR BLVD
Second Line	:
City	:	WARR ACRES
State	:	OK
Zip	:	73132-6503
Country	:	US
Telephone Number	:	405-495-1001
Fax Number	:

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

Provider Enumeration Date	:	01/04/2021
Last Update Date	:	01/04/2021

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Directions to “ MATTHEW TYLER GREEN DPH” Practice Location

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