Provider Demographics
NPI:1679273155
Name:GREEN, ALEXANDRIA (PHARMD RPH)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:PHARMD RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3418 BIG SKY PASS
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6084
Mailing Address - Country:US
Mailing Address - Phone:901-493-9581
Mailing Address - Fax:
Practice Address - Street 1:1710 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5604
Practice Address - Country:US
Practice Address - Phone:281-482-5516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist