Healthcare Provider Details

I. General information

NPI: 1467552141
Provider Name (Legal Business Name): DAVID LEE GREENE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 W MAIN ST
STEELE MO
63877-1434
US

IV. Provider business mailing address

128 W MAIN ST
STEELE MO
63877-1434
US

V. Phone/Fax

Practice location:
  • Phone: 573-695-4533
  • Fax: 573-695-3327
Mailing address:
  • Phone: 573-695-4533
  • Fax: 573-695-3327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number040616
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: