Provider Demographics
NPI:1730435835
Name:GREEN, SHANNON MARIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MARIE
Last Name:GREEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:CONWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11900 STAGE RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:NY
Mailing Address - Zip Code:14001
Mailing Address - Country:US
Mailing Address - Phone:716-863-6850
Mailing Address - Fax:
Practice Address - Street 1:390 W MAIN ST
Practice Address - Street 2:TOPS MARKETS LLC
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020
Practice Address - Country:US
Practice Address - Phone:585-343-9545
Practice Address - Fax:855-331-9042
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist