Provider Demographics
NPI:1225746449
Name:GREEN, LIAN (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:LIAN
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26288 KUYKENDAHL RD
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-2657
Mailing Address - Country:US
Mailing Address - Phone:281-378-2995
Mailing Address - Fax:
Practice Address - Street 1:26288 KUYKENDAHL RD
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-2657
Practice Address - Country:US
Practice Address - Phone:281-378-2995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist