Provider Demographics
NPI:1053628818
Name:GREENE, JOHN S (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:GREENE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25495 RAVENWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-8255
Mailing Address - Country:US
Mailing Address - Phone:850-567-9126
Mailing Address - Fax:904-212-1042
Practice Address - Street 1:25495 RAVENWOOD CIR
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-8255
Practice Address - Country:US
Practice Address - Phone:850-567-9126
Practice Address - Fax:904-212-1042
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL32083183500000X
AL13379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist