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NPI Code Detail

MEDICARE: MR. STANLEY A GREEN R. PH.

MEDICARE: MR. STANLEY A GREEN R. PH.
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
1183500000XPharmacistPHA27519CA

General Provider Information

NPI Number : 1528067030
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. STANLEY A GREEN R. PH.
Provider Business Mailing Address
First Line : 1196 HAWTHORNE CT
Second Line :
City : SEBASTOPOL
State : CA
Zip : 95472-4449
Country : US
Telephone Number : 707-824-8588
Fax Number :
Provider Business Practice Location Address
First Line : 144 STONY POINT RD
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-4122
Country : US
Telephone Number : 707-521-4585
Fax Number : 707-521-4599
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2005
Last Update Date : 07/08/2007

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