Healthcare Provider Details

I. General information

NPI: 1932376373
Provider Name (Legal Business Name): DAVID LYAL GREEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 GEORGIA AVE
WASHINGTON DC
20307
US

IV. Provider business mailing address

6900 GEORGIA AVE
WASHINGTON DC
20307
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-6224
  • Fax: 202-782-0410
Mailing address:
  • Phone: 202-782-6224
  • Fax: 202-782-0410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number9640
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051290310
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0202010157
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: