Provider Demographics
NPI:1326034364
Name:GREEN, KAREN D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:D
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 1:101 VERNON AVE
Mailing Address - Street 2:PANAMA CITY VA CBOC (NSA PANAMA CITY)
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32407-7018
Mailing Address - Country:US
Mailing Address - Phone:850-636-7000
Mailing Address - Fax:850-636-7060
Practice Address - Street 1:101 VERNON AVE
Practice Address - Street 2:PANAMA CITY VA CBOC (NSA PANAMA CITY)
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32407-7018
Practice Address - Country:US
Practice Address - Phone:850-636-7000
Practice Address - Fax:850-636-7060
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14396183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist