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General NPI Number Information
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NPI Number | 1639548944
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Entity Type | Individual
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Provider Name | MR. JAMES EARL GREEN
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Gender | Male
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Dates
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Enumeration Date | 09/16/2015
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Last Update Date | 09/16/2015
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Provider Practice Location Address
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Address Line | 1401 OLD EXETER RD WALMART PHARMACY #0914
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City | CASSVILLE
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State | MO
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Zip | 65625-9430
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Country | US
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Telephone | 417-847-3180
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Fax | 417-847-3650
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Provider Business Mailing Address
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Address Line | 1401 OLD EXETER RD WALMART PHARMACY #0914
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City | CASSVILLE
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State | MO
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Zip | 65625-9430
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Country | US
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Telephone | 417-847-3180
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Fax | 417-847-3650
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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 | 040660
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License Number State | MO
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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 | 8917
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License Number State | NE
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