Provider Demographics
NPI:1891065439
Name:GREEN, RUTH LORRAINE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:LORRAINE
Last Name:GREEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 JOHN ROLFE PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-6913
Mailing Address - Country:US
Mailing Address - Phone:804-360-1869
Mailing Address - Fax:804-360-1082
Practice Address - Street 1:2250 JOHN ROLFE PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-6913
Practice Address - Country:US
Practice Address - Phone:804-360-1869
Practice Address - Fax:804-360-1082
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202207618OtherBOARD OF PHARMACY (VA)