Provider Demographics
NPI:1609472893
Name:GREEN, LORRAINE (RPH, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:DR
Other - First Name:LORRAINE
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH, PHARMD
Mailing Address - Street 1:7 FAIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1618
Mailing Address - Country:US
Mailing Address - Phone:973-590-4937
Mailing Address - Fax:
Practice Address - Street 1:178 E HANOVER AVE
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-2038
Practice Address - Country:US
Practice Address - Phone:973-829-6820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03586200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist