Provider Demographics
NPI:1508198995
Name:GREENE, PETER E (RPH)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:E
Last Name:GREENE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:PETER
Other - Middle Name:E
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:11512 NE 56TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-4503
Mailing Address - Country:US
Mailing Address - Phone:360-574-3042
Mailing Address - Fax:
Practice Address - Street 1:3200 NE 52ND ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-1919
Practice Address - Country:US
Practice Address - Phone:360-574-3042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00016871183500000X
OR7107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist