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General NPI Number Information
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NPI Number | 1225582760
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Entity Type | Individual
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Provider Name | JUSTIN TYLER GREEN PHARM.D
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Gender | Male
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Dates
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Enumeration Date | 08/13/2016
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 9815 ROSE COMMONS DR
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-3334
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Country | US
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Telephone | 704-948-4806
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Fax | 704-464-3234
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Provider Business Mailing Address
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Address Line | 9815 ROSE COMMONS DR
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-3334
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Country | US
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Telephone | 704-948-4806
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Fax | 704-464-3234
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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 | 26444
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 36767
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License Number State | SC
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