Healthcare Provider Details

I. General information

NPI: 1427598762
Provider Name (Legal Business Name): ELISA GREENE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 GALE LN
NASHVILLE TN
37204-3012
US

IV. Provider business mailing address

1900 BELMONT BLVD
NASHVILLE TN
37212-3758
US

V. Phone/Fax

Practice location:
  • Phone: 615-298-5406
  • Fax:
Mailing address:
  • Phone: 615-460-5708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number36020
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: