Provider Demographics
NPI:1518226463
Name:GREEN, SALLY K (RPH)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:K
Last Name:GREEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7250 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-7128
Mailing Address - Country:US
Mailing Address - Phone:253-475-1994
Mailing Address - Fax:253-475-6082
Practice Address - Street 1:7250 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-7128
Practice Address - Country:US
Practice Address - Phone:253-475-1994
Practice Address - Fax:253-475-6082
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00007844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist