Provider Demographics
NPI:1659653244
Name:GREENE, RICHARD CHARLES (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:CHARLES
Last Name:GREENE
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 1:1610 HIGHWAY 17 S
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-6082
Mailing Address - Country:US
Mailing Address - Phone:843-650-4536
Mailing Address - Fax:843-650-4536
Practice Address - Street 1:1610 HIGHWAY 17 S
Practice Address - Street 2:
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-6082
Practice Address - Country:US
Practice Address - Phone:843-650-4536
Practice Address - Fax:843-650-4536
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC007676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC007676OtherSOUTH CAROLINA PHARMACIST LICENSE