Provider Demographics
NPI:1245332030
Name:GREENE, RONALD SHANE (PHARMD, BCPS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:SHANE
Last Name:GREENE
Suffix:
Gender:M
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 MCGARRY LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7926
Mailing Address - Country:US
Mailing Address - Phone:817-437-5539
Mailing Address - Fax:
Practice Address - Street 1:900 JEROME ST STE 400
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3942
Practice Address - Country:US
Practice Address - Phone:817-732-6060
Practice Address - Fax:817-731-2541
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX385871835P1200X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist