Provider Demographics
NPI:1376635490
Name:GREENE, REBECCA ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ELIZABETH
Last Name:GREENE
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 1:633 N PARK AVE
Mailing Address - Street 2:#8A
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3263
Mailing Address - Country:US
Mailing Address - Phone:210-557-4748
Mailing Address - Fax:
Practice Address - Street 1:5201 RAYMOND ST
Practice Address - Street 2:119
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-8208
Practice Address - Country:US
Practice Address - Phone:407-629-1599
Practice Address - Fax:407-646-4516
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist