Provider Demographics
NPI:1851845416
Name:GREEN, JOSHUA (RPH)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:GREEN
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 1:1960 N FEDERAL BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-5204
Mailing Address - Country:US
Mailing Address - Phone:307-856-2261
Mailing Address - Fax:
Practice Address - Street 1:1960 N FEDERAL BLVD
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-5204
Practice Address - Country:US
Practice Address - Phone:307-856-2261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist