Provider Demographics
NPI:1467552141
Name:GREENE, DAVID LEE (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEE
Last Name:GREENE
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 1:128 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STEELE
Mailing Address - State:MO
Mailing Address - Zip Code:63877-1434
Mailing Address - Country:US
Mailing Address - Phone:573-695-4533
Mailing Address - Fax:573-695-3327
Practice Address - Street 1:128 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STEELE
Practice Address - State:MO
Practice Address - Zip Code:63877-1434
Practice Address - Country:US
Practice Address - Phone:573-695-4533
Practice Address - Fax:573-695-3327
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO040616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist