Provider Demographics
NPI:1295146744
Name:GREENE, CARNECIA YVONNE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:CARNECIA
Middle Name:YVONNE
Last Name:GREENE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CARNECIA
Other - Middle Name:YVONNE
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:11125 DUNN ROAD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6132
Mailing Address - Country:US
Mailing Address - Phone:314-653-5200
Mailing Address - Fax:314-653-4431
Practice Address - Street 1:11125 DUNN ROAD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6132
Practice Address - Country:US
Practice Address - Phone:314-657-9002
Practice Address - Fax:314-653-4115
Is Sole Proprietor?:No
Enumeration Date:2014-05-17
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007035544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist