1295146744 NPI number — MRS. CARNECIA YVONNE GREENE PHARM.D.

Table of content: MRS. CARNECIA YVONNE GREENE PHARM.D. (NPI 1295146744)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295146744 NPI number — MRS. CARNECIA YVONNE GREENE PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREENE
Provider First Name:
CARNECIA
Provider Middle Name:
YVONNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLE
Provider Other First Name:
CARNECIA
Provider Other Middle Name:
YVONNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARM.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295146744
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11125 DUNN ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63136-6132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-653-5200
Provider Business Mailing Address Fax Number:
314-653-4431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11125 DUNN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63136-6132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-657-9002
Provider Business Practice Location Address Fax Number:
314-653-4115
Provider Enumeration Date:
05/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  2007035544 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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