Provider Demographics
NPI:1588735146
Name:GREEN, CHARLES GOODWIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:GOODWIN
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:PO BOX 1006
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-1006
Mailing Address - Country:US
Mailing Address - Phone:770-267-2539
Mailing Address - Fax:
Practice Address - Street 1:221 S MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-1629
Practice Address - Country:US
Practice Address - Phone:770-267-2539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH014218183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist