Provider Demographics
NPI:1710100235
Name:GREENE, HARLAND BRADFORD JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:HARLAND
Middle Name:BRADFORD
Last Name:GREENE
Suffix:JR
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 1:2414 FORREST CREST CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-3777
Mailing Address - Country:US
Mailing Address - Phone:813-971-0931
Mailing Address - Fax:
Practice Address - Street 1:8424 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1606
Practice Address - Country:US
Practice Address - Phone:813-886-9427
Practice Address - Fax:813-886-9280
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0019909183500000X
MAPS0018913183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0556050375Medicare ID - Type Unspecified