Provider Demographics
NPI:1164770012
Name:GREENE, JILL H (RPH)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:H
Last Name:GREENE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-2230
Mailing Address - Country:US
Mailing Address - Phone:864-573-5313
Mailing Address - Fax:864-582-1532
Practice Address - Street 1:1751 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-2230
Practice Address - Country:US
Practice Address - Phone:864-573-5313
Practice Address - Fax:864-582-1532
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist