Healthcare Provider Details

I. General information

NPI: 1154415560
Provider Name (Legal Business Name): GREEN SPECIALTY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

G3333 BEECHER RD B
FLINT MI
48532-3619
US

IV. Provider business mailing address

G3333 BEECHER RD # B
FLINT MI
48532-3619
US

V. Phone/Fax

Practice location:
  • Phone: 810-230-9900
  • Fax: 810-230-9988
Mailing address:
  • Phone: 810-230-9900
  • Fax: 810-230-9988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301008892
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number5301008892
License Number StateMI

VIII. Authorized Official

Name: MANISH PATEL
Title or Position: PRESIDENT
Credential: RPH
Phone: 810-230-9900