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NPI Code Detail

MEDICARE: MARY CATHERINE GREEN RPH

MEDICARE: MARY CATHERINE GREEN RPH
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
1183500000XPharmacist14276OK

General Provider Information

NPI Number : 1750664702
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY CATHERINE GREEN RPH
Provider Business Mailing Address
First Line : 1608 HILLCREST DR
Second Line :
City : HENRYETTA
State : OK
Zip : 74437-1900
Country : US
Telephone Number : 903-870-8378
Fax Number :
Provider Business Practice Location Address
First Line : 1000 E CARL ALBERT PKWY
Second Line :
City : MCALESTER
State : OK
Zip : 74501-5121
Country : US
Telephone Number : 918-426-7657
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2011
Last Update Date : 09/27/2011

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Directions to “ MARY CATHERINE GREEN RPH” Practice Location

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