GREEN BROTHERS PHARMACY INC (NPI# 1265548119) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265548119 |
| Entity Type | Organization |
| Organization Name | GREEN BROTHERS PHARMACY INC |
| Other Organization Name | GREEN BROTHERS PHARMACY |
| Practice Address |
1610 N El Dorado St Ste 1 Stockton CA 95204-5930 |
| Practice Telephone | 2094662381 |
| Practice Fax Number | 2094651398 |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | CHARLES GREEN (CEO) |
| Authorized Official Telephone | 2094662381 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 333600000X | Pharmacy | PHY10612 | CA | Suppliers |
| X | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OTHER ID NUMBER-COMMERCIAL NUMBER | 0509464 | 01 | |
| CA | PHD106120 | 05 |
| Other Name | Type Code |
|---|---|
| GREEN BROTHERS PHARMACY | Doing Business As Name - Organization |
| Street Address |
1610 N EL DORADO ST STE 1 |
| City | STOCKTON |
| State | CA |
| Zip Code | 95204-5930 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962027524 | Kariem Abdelwahed | Licensed Vocational Nurse | 1630 N. Edison St Stockton Ca, Stockton, CA 95204 | 2020-06-10 |
| 1831730555 | Ronnie C Murray | Counselor | 1947 North California Street, Stockton, CA 95204 | 2019-10-03 |
| 1235614116 | Michelle Ann Horn | Marriage & Family Therapist | 3666 Mission Rd, Stockton, CA 95204 | 2018-09-26 |
| 1356830947 | Stockton Pace | PACE Provider Organization | 582 E. Harding Way, Stockton, CA 95204 | 2018-05-09 |
| 1790228781 | Rebecca Phongsa | Counselor | 1947 North Calfornia Street, Suite B, Stockton, CA 95204 | 2016-11-23 |
| 1700332905 | Serim Kang | Driver | 4222 N Pershing Ave, Suite D2, Stockton, CA 95204 | 2016-08-28 |
| 1033565544 | Philip John Brereton | Orthotist | 466 E Harding Way, Stockton, CA 95204 | 2016-05-13 |
| 1932507522 | David Grayson | Counselor | 1621 Brookside Rd, Stockton, CA 95204 | 2014-12-12 |
| 1174934897 | Gurtej Malhi | Internal Medicine | 1901 N California Street, Stockton, CA 95204 | 2014-05-15 |
| 1396156170 | Rajesh Saini | Nurse Practitioner | 1805 N California St. Suite 102, Stockton, CA 95204 | 2014-05-14 |
| Find all providers in zip 95204 | ||||
| Taxonomy Code | 333600000X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548893779 | Corrections and Rehabilitation | Pharmacy | 7707 South Austin Road, Stockton, CA 95215-8312 | 2020-02-17 |
| 1326186180 | Bluepoint Pharmacy Inc | Pharmacy | 7743 Nest Lane, B3, Stockton, CA 95210 | 2007-02-02 |
| 1114078110 | Parkwoods Drug | Pharmacy | 104 Lincoln Ctr, Stockton, CA 95207 | 2007-01-16 |
| 1457409062 | Kaiser Foundation Health Plan Inc | Pharmacy | 7373 West Ln Fl 3, Stockton, CA 95210-3377 | 2007-01-08 |
| 1568527984 | Day and Night Drug Store Inc | Pharmacy | 134 E Weber Ave, Stockton, CA 95202-2705 | 2006-12-26 |
| 1467513549 | Stockton Pharmacy | Pharmacy | 3330 E Main St, Stockton, CA 95205 | 2006-12-13 |
| 1013078187 | Charter Way Pharmacy | Pharmacy | 201 W Charter Wy, Stockton, CA 95206 | 2006-12-13 |
| 1063591733 | Carepoint Pharmacy Inc | Pharmacy | 73 W March Ln Ste D, Stockton, CA 95207-5726 | 2006-11-03 |
| 1821170366 | Care Rx LLC | Pharmacy | 7720 Lorraine Ave, Stockton, CA 95210-4203 | 2006-10-20 |
| 1538102868 | Longs Drug Stores California LLC | Pharmacy | 2605 W March Ln, Stockton, CA 95207-6522 | 2006-06-14 |
| Find all providers in STOCKTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.