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NPI Code Detail

MEDICARE: AMY ELLEN GREEN CPHT-ADV

MEDICARE: AMY ELLEN GREEN CPHT-ADV
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
1183700000XPharmacy Technician67010078AIN

General Provider Information

NPI Number : 1649075839
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY ELLEN GREEN CPHT-ADV
Provider Business Mailing Address
First Line : 3444 S SADLIER DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46239-1222
Country : US
Telephone Number : 317-667-3649
Fax Number :
Provider Business Practice Location Address
First Line : 8405 SOUTHEASTERN AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46239-1348
Country : US
Telephone Number : 317-862-2414
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2025
Last Update Date : 02/13/2025

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Directions to “ AMY ELLEN GREEN CPHT-ADV” Practice Location

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