Provider Demographics
NPI:1073861571
Name:GREEN, JESSICA ERIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ERIN
Last Name:GREEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 MILES RD
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-2119
Mailing Address - Country:US
Mailing Address - Phone:936-404-4065
Mailing Address - Fax:
Practice Address - Street 1:969 MILES RD
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-2119
Practice Address - Country:US
Practice Address - Phone:936-404-4065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist