Provider Demographics
NPI:1336696061
Name:GREENLEE, MAX EDWIN (RPH)
Entity Type:Individual
Prefix:DR
First Name:MAX
Middle Name:EDWIN
Last Name:GREENLEE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13400 VALERIE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-8745
Mailing Address - Country:US
Mailing Address - Phone:850-207-9602
Mailing Address - Fax:
Practice Address - Street 1:13400 VALERIE DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-8745
Practice Address - Country:US
Practice Address - Phone:850-207-9602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-11
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 55385183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist