Provider Demographics
NPI:1023339751
Name:GREEN, RONALD ALAN (RPH)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:ALAN
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 1:5633 BAUM BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3778
Mailing Address - Country:US
Mailing Address - Phone:412-441-6991
Mailing Address - Fax:412-441-6945
Practice Address - Street 1:5633 BAUM BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3778
Practice Address - Country:US
Practice Address - Phone:412-441-6991
Practice Address - Fax:412-441-6945
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist