MEDICARE: AMY MARIE GREEN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202220665	VA

General Provider Information

NPI Number	:	1003534140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MARIE GREEN PHARMD

Provider Business Mailing Address
First Line	:	74 CARRERA CT
Second Line	:
City	:	INWOOD
State	:	WV
Zip	:	25428-4429
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1950 S PLEASANT VALLEY RD
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-4400
Country	:	US
Telephone Number	:	540-665-0908
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2022
Last Update Date	:	08/15/2022

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