Provider Demographics
NPI:1215290812
Name:GREEN, DAVID CHRISTOPHER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHRISTOPHER
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 1:5029 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3911
Mailing Address - Country:US
Mailing Address - Phone:301-927-0829
Mailing Address - Fax:
Practice Address - Street 1:4720 CHERRY HILL RD
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-1330
Practice Address - Country:US
Practice Address - Phone:301-345-7738
Practice Address - Fax:301-345-6118
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19509183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist