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General NPI Number Information
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NPI Number | 1467865220
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Entity Type | Organization
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Legal Business Name | GREEN HARBOUR PHARMACY INC
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Dates
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Enumeration Date | 06/09/2014
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Last Update Date | 06/09/2014
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Provider Practice Location Address
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Address Line | 1323 W COLTON AVE SUITE 120
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City | REDLANDS
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State | CA
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Zip | 92374-4554
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Country | US
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Telephone | 909-666-7551
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Fax | 909-666-5300
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Provider Business Mailing Address
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Address Line | PO BOX 455
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City | REDLANDS
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State | CA
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Zip | 92373-0141
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Country | US
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Telephone | 909-666-7551
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Fax | 909-666-5300
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Authorized Official
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Title or Position | SECRETARY TRESURER
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Name | MR. CHARLES R GREEN JR.
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Credential |
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Telephone | 909-666-7551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State | CA
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