Provider Demographics
NPI:1326822933
Name:GREEN, JOSHUA RYAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:RYAN
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 1:400 S CHARLES ST APT 5
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-6938
Mailing Address - Country:US
Mailing Address - Phone:870-834-3088
Mailing Address - Fax:
Practice Address - Street 1:3509 E RACE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6202
Practice Address - Country:US
Practice Address - Phone:501-268-4946
Practice Address - Fax:501-268-4949
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD16683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist