Provider Demographics
NPI:1578159265
Name:HUGHES-GREEN, SANDRA LEIGH
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEIGH
Last Name:HUGHES-GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3192 ROUTE 115
Mailing Address - Street 2:
Mailing Address - City:EFFORT
Mailing Address - State:PA
Mailing Address - Zip Code:18330-9113
Mailing Address - Country:US
Mailing Address - Phone:570-688-2303
Mailing Address - Fax:570-688-2307
Practice Address - Street 1:3192 ROUTE 115
Practice Address - Street 2:
Practice Address - City:EFFORT
Practice Address - State:PA
Practice Address - Zip Code:18330-9113
Practice Address - Country:US
Practice Address - Phone:570-688-2302
Practice Address - Fax:570-688-2307
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist