Healthcare Provider Details

I. General information

NPI: 1154874014
Provider Name (Legal Business Name): JULIA GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 FRANKFORD AVE
PHILADELPHIA PA
19135-1605
US

IV. Provider business mailing address

182 GAY ST UNIT 805
PHILADELPHIA PA
19128-4801
US

V. Phone/Fax

Practice location:
  • Phone: 484-515-2242
  • Fax:
Mailing address:
  • Phone: 484-515-2242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRP449114
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: