1154415560 NPI number — GREEN SPECIALTY PHARMACY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154415560 NPI number — GREEN SPECIALTY PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREEN SPECIALTY PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BENZER PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154415560
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
G3333 BEECHER RD # B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48532-3619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-230-9900
Provider Business Mailing Address Fax Number:
810-230-9988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
G3333 BEECHER RD
Provider Second Line Business Practice Location Address:
B
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48532-3619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-230-9900
Provider Business Practice Location Address Fax Number:
810-230-9988
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
MANISH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
810-230-9900

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  5301008892 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X , with the licence number: 5301008892 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2368858 . This is a "OTHER ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2368858 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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