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General NPI Number Information
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NPI Number | 1871581595
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Entity Type | Individual
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Provider Name | KELLY ALISSA GREEN PHARM.D., PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/06/2005
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 1295 N. MARTIN ROOM B308
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City | TUCSON
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State | AZ
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Zip | 85712
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Country | US
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Telephone | 520-626-6016
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Fax |
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Provider Business Mailing Address
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Address Line | 7566 N LA CHOLLA BLVD STE A
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City | TUCSON
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State | AZ
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Zip | 85741-2307
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Country | US
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Telephone | 520-742-4139
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 12514
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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