Provider Demographics
NPI:1720360423
Name:DANIEL-GREENE, JOAN LISA
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:LISA
Last Name:DANIEL-GREENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 MAPLEWOOD DR SW
Mailing Address - Street 2:
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-2699
Mailing Address - Country:US
Mailing Address - Phone:256-751-0496
Mailing Address - Fax:
Practice Address - Street 1:1718 BELTLINE RD SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-5510
Practice Address - Country:US
Practice Address - Phone:256-584-6626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist