MEDICARE: KIMBERLY ANN GREENE PHARM.D.

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	70984	CA

General Provider Information

NPI Number	:	1881094084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANN GREENE PHARM.D.

Provider Business Mailing Address
First Line	:	2627 H ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-4321
Country	:	US
Telephone Number	:	530-415-0498
Fax Number	:

Provider Business Practice Location Address
First Line	:	602 MAIN ST
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95695-3405
Country	:	US
Telephone Number	:	530-662-2813
Fax Number	:

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

Provider Enumeration Date	:	08/26/2014
Last Update Date	:	08/26/2014

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