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NPI Code Detail

MEDICARE: SETH B GREEN RPH

MEDICARE: SETH B 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
11835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist9144986-1701UT

General Provider Information

NPI Number : 1841716354
Entity Type Code : Individual
Provider Name (Legal Business Name) : SETH B GREEN RPH
Provider Business Mailing Address
First Line : 2332 E 2100 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84109-1319
Country : US
Telephone Number : 801-466-9949
Fax Number :
Provider Business Practice Location Address
First Line : 2332 E 2100 S
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84109-1319
Country : US
Telephone Number : 801-466-9949
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2017
Last Update Date : 07/21/2022

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