Provider Demographics
NPI:1689989535
Name:GREEN, PAULA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19201
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39122-9201
Mailing Address - Country:US
Mailing Address - Phone:601-870-6113
Mailing Address - Fax:
Practice Address - Street 1:303 DEVEREAUX DR
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4207
Practice Address - Country:US
Practice Address - Phone:601-870-6113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-010147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist