Provider Demographics
NPI:1235476060
Name:GREEN, BRETT J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:J
Last Name:GREEN
Suffix:
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 1:5771 ROOSEVELT BLVD STE 410
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-3415
Mailing Address - Country:US
Mailing Address - Phone:727-523-2515
Mailing Address - Fax:
Practice Address - Street 1:5771 ROOSEVELT BLVD STE 410
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3415
Practice Address - Country:US
Practice Address - Phone:727-523-2515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist