Provider Demographics
NPI:1932376373
Name:GREEN, DAVID LYAL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LYAL
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 1:6900 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20307
Mailing Address - Country:US
Mailing Address - Phone:202-782-6224
Mailing Address - Fax:202-782-0410
Practice Address - Street 1:6900 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307
Practice Address - Country:US
Practice Address - Phone:202-782-6224
Practice Address - Fax:202-782-0410
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE96401835P0018X
IL0512903101835P0018X
VA02020101571835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist