MEDICARE: MR. RICHARD GORDON GREENSTEIN BS

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	PS30168	FL

General Provider Information

NPI Number	:	1164705232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD GORDON GREENSTEIN BS

Provider Business Mailing Address
First Line	:	8379 HORSESHOE BAY RD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-5045
Country	:	US
Telephone Number	:	561-734-5579
Fax Number	:

Provider Business Practice Location Address
First Line	:	10951 JOG RD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3921
Country	:	US
Telephone Number	:	561-734-6848
Fax Number	:

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

Provider Enumeration Date	:	09/24/2011
Last Update Date	:	09/24/2011

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