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NPI Code Detail

MEDICARE: REGINALD EUGENE GREEN JR.

MEDICARE: REGINALD EUGENE GREEN JR.
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
1183500000XPharmacist37301SC

General Provider Information

NPI Number : 1558886077
Entity Type Code : Individual
Provider Name (Legal Business Name) : REGINALD EUGENE GREEN JR.
Provider Business Mailing Address
First Line : 101 FOUNDERS BAY RD
Second Line :
City : MURRELLS INLET
State : SC
Zip : 29576-8089
Country : US
Telephone Number : 843-651-8863
Fax Number : 843-651-8864
Provider Business Practice Location Address
First Line : 101 FOUNDERS BAY RD
Second Line :
City : MURRELLS INLET
State : SC
Zip : 29576-8089
Country : US
Telephone Number : 843-651-8863
Fax Number : 843-651-8864
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2017
Last Update Date : 08/04/2017

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