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General NPI Number Information
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NPI Number | 1083969588
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Entity Type | Individual
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Provider Name | NATHANIEL GREEN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/20/2012
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Last Update Date | 07/20/2012
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Provider Practice Location Address
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Address Line | 1025 S MILTON RD
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-6349
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Country | US
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Telephone | 928-779-9588
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Fax |
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Provider Business Mailing Address
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Address Line | 78 N GRANADA CIR
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City | CASA GRANDE
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State | AZ
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Zip | 85122-5706
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Country | US
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Telephone | 520-229-7196
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | S019128
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License Number State | AZ
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