Provider Demographics
NPI:1720676604
Name:GREEN, BILLY THERON JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:BILLY
Middle Name:THERON
Last Name:GREEN
Suffix:JR
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:PO BOX 313
Mailing Address - Street 2:
Mailing Address - City:ZELLWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32798-0313
Mailing Address - Country:US
Mailing Address - Phone:361-443-2241
Mailing Address - Fax:
Practice Address - Street 1:5040 KING AVE
Practice Address - Street 2:
Practice Address - City:ZELLWOOD
Practice Address - State:FL
Practice Address - Zip Code:32798-0313
Practice Address - Country:US
Practice Address - Phone:361-443-2241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA164851835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy