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NPI Code Detail

MEDICARE: CORNELIA GREENE PHARM D

MEDICARE: CORNELIA GREENE PHARM D
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
1183500000XPharmacistPST.022700LA
21835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistPST.022700LA

General Provider Information

NPI Number : 1457829756
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORNELIA GREENE PHARM D
Provider Business Mailing Address
First Line : 510 E STONER AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71101-4243
Country : US
Telephone Number : 318-990-5547
Fax Number :
Provider Business Practice Location Address
First Line : 510 E STONER AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71101-4243
Country : US
Telephone Number : 318-990-5547
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2018
Last Update Date : 06/05/2026

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Directions to “ CORNELIA GREENE PHARM D” Practice Location

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