Provider Demographics
NPI:1043863129
Name:GREEN, WILLIAM JOSEPH JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:GREEN
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 LEWIS FARM DR
Mailing Address - Street 2:
Mailing Address - City:COCHRANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19330-9352
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2012 BRACKENVILLE RD
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-9568
Practice Address - Country:US
Practice Address - Phone:302-234-5710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0005415183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist