Provider Demographics
NPI:1609859719
Name:GREEN, DANIEL H (RPH)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:H
Last Name:GREEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7802 HIGHWAY 25 E
Mailing Address - Street 2:P.O. BOX 178
Mailing Address - City:CROSS PLAINS
Mailing Address - State:TN
Mailing Address - Zip Code:37049-4848
Mailing Address - Country:US
Mailing Address - Phone:615-654-3877
Mailing Address - Fax:615-654-9179
Practice Address - Street 1:7802 HIGHWAY 25 E
Practice Address - Street 2:
Practice Address - City:CROSS PLAINS
Practice Address - State:TN
Practice Address - Zip Code:37049-4848
Practice Address - Country:US
Practice Address - Phone:615-654-3877
Practice Address - Fax:615-654-9179
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2023-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1173190001Medicare ID - Type Unspecified