Provider Demographics
NPI:1154120210
Name:GREENE, BRANDY K (PHARMD, BCPS)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:K
Last Name:GREENE
Suffix:
Gender:
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W FOREVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-9848
Mailing Address - Country:US
Mailing Address - Phone:319-335-3500
Mailing Address - Fax:
Practice Address - Street 1:701 W FOREVERGREEN RD
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-9848
Practice Address - Country:US
Practice Address - Phone:319-335-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22637183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist