MEDICARE: MRS. CHANDRA JORDAN GREEN

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	15286	LA

General Provider Information

NPI Number	:	1609181809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHANDRA JORDAN GREEN

Provider Business Mailing Address
First Line	:	11297 LAKE FOREST BLVD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70128-2822
Country	:	US
Telephone Number	:	504-248-2898
Fax Number	:	504-248-2892

Provider Business Practice Location Address
First Line	:	11297 LAKE FOREST BLVD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70128-2822
Country	:	US
Telephone Number	:	504-248-2898
Fax Number	:	504-248-2892

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

Provider Enumeration Date	:	08/11/2010
Last Update Date	:	08/11/2010

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