Provider Demographics
NPI:1841582046
Name:GREEN, BRANDON SCOTT (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:SCOTT
Last Name:GREEN
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3368 BLACKFORD PKWY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-9070
Mailing Address - Country:US
Mailing Address - Phone:606-776-5557
Mailing Address - Fax:
Practice Address - Street 1:3368 BLACKFORD PKWY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-9070
Practice Address - Country:US
Practice Address - Phone:606-776-5557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist