Provider Demographics
NPI:1144543513
Name:GREEN, PAM M (RPH)
Entity type:Individual
Prefix:
First Name:PAM
Middle Name:M
Last Name:GREEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 N GALE ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14787-9792
Mailing Address - Country:US
Mailing Address - Phone:716-763-0966
Mailing Address - Fax:716-763-1334
Practice Address - Street 1:70 N GALE ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NY
Practice Address - Zip Code:14787-9792
Practice Address - Country:US
Practice Address - Phone:716-763-0966
Practice Address - Fax:716-763-1334
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048216183500000X
PARP438823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist