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General NPI Number Information
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NPI Number | 1710310529
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Entity Type | Individual
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Provider Name | CHARLIE JAMES GREEN PHARM. D.
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Gender | Male
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Dates
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Enumeration Date | 08/15/2013
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Last Update Date | 08/15/2013
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Provider Practice Location Address
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Address Line | 19 PORTLAND RD
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City | BRIDGTON
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State | ME
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Zip | 04009-1229
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Country | US
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Telephone | 207-647-3445
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Fax | 207-647-2086
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Provider Business Mailing Address
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Address Line | 39 SPRUCE ST
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City | SANFORD
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State | ME
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Zip | 04073-2970
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Country | US
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Telephone | 207-432-2857
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Fax |
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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 | PR12947
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License Number State | ME
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