Provider Demographics
NPI:1063988061
Name:GREEN, BRENDAN MICHAEL (PHARMD)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:MICHAEL
Last Name:GREEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10402 LYNDON MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-6674
Mailing Address - Country:US
Mailing Address - Phone:615-828-6524
Mailing Address - Fax:
Practice Address - Street 1:13114 FM 1960 RD W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4290
Practice Address - Country:US
Practice Address - Phone:713-442-4055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist