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General NPI Number Information
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NPI Number | 1154415560
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Entity Type | Organization
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Legal Business Name | GREEN SPECIALTY PHARMACY
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 11/04/2008
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Provider Practice Location Address
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Address Line | G3333 BEECHER RD B
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City | FLINT
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State | MI
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Zip | 48532-3619
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Country | US
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Telephone | 810-230-9900
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Fax | 810-230-9988
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Provider Business Mailing Address
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Address Line | G3333 BEECHER RD # B
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City | FLINT
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State | MI
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Zip | 48532-3619
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Country | US
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Telephone | 810-230-9900
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Fax | 810-230-9988
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Authorized Official
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Title or Position | PRESIDENT
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Name | MANISH PATEL
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Credential | RPH
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Telephone | 810-230-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 5301008892
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301008892
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License Number State | MI
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