Provider Demographics
NPI:1578119848
Name:GREEN, GEANNETTE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GEANNETTE
Middle Name:
Last Name:GREEN
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 1:4110 GEORGE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7490
Mailing Address - Country:US
Mailing Address - Phone:813-206-6200
Mailing Address - Fax:
Practice Address - Street 1:4110 GEORGE RD STE 150
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-7490
Practice Address - Country:US
Practice Address - Phone:813-206-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist