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General NPI Number Information
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NPI Number | 1366736613
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Entity Type | Organization
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Legal Business Name | GREEN PHARMACY
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Dates
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Enumeration Date | 06/04/2011
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Last Update Date | 06/04/2011
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Provider Practice Location Address
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Address Line | 150 S OAK PARK AVE UNIT 307
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City | OAK PARK
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State | IL
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Zip | 60302-2984
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Country | US
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Telephone | 312-731-7564
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Fax |
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Provider Business Mailing Address
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Address Line | 219 W BUFFALO ST
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City | NEW BUFFALO
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State | MI
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Zip | 49117-1807
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ERIC YANG
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Credential |
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Telephone | 312-731-7564
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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 |
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License Number State |
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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 |
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License Number State |
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