Provider Demographics
NPI:1932658291
Name:SPRING GREEN PHARMACY
Entity Type:Organization
Organization Name:SPRING GREEN PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:HARSH
Authorized Official - Middle Name:
Authorized Official - Last Name:VARDHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-650-6768
Mailing Address - Street 1:1443 FM 1463 RD
Mailing Address - Street 2:SUITE 650
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5479
Mailing Address - Country:US
Mailing Address - Phone:281-942-4330
Mailing Address - Fax:
Practice Address - Street 1:1443 FM 1463 RD
Practice Address - Street 2:SUITE 650
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-5479
Practice Address - Country:US
Practice Address - Phone:281-942-4330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTSIDE PHARMACY LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy