Provider Demographics
NPI:1841890126
Name:GREEN, DONNA DUDNEY
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:DUDNEY
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 HIGHWAY 79 N
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-3265
Mailing Address - Country:US
Mailing Address - Phone:870-234-5421
Mailing Address - Fax:
Practice Address - Street 1:60 HIGHWAY 79 N
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-3265
Practice Address - Country:US
Practice Address - Phone:870-234-5421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD06651183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist