Provider Demographics
NPI:1770248429
Name:GREEN, AARON MICHAEL
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:MICHAEL
Last Name:GREEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CREEKVIEW CIR APT 1215
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-1110
Mailing Address - Country:US
Mailing Address - Phone:724-493-8705
Mailing Address - Fax:
Practice Address - Street 1:318 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-5506
Practice Address - Country:US
Practice Address - Phone:412-321-3553
Practice Address - Fax:412-321-8828
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-07
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP456203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist