Provider Demographics
NPI:1174803613
Name:GREENE, SEAN P (RPH)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:P
Last Name:GREENE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 NE EXPY NE STE B800
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-1828
Mailing Address - Country:US
Mailing Address - Phone:404-367-9111
Mailing Address - Fax:
Practice Address - Street 1:896 HIGHWAY 81 E
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-2914
Practice Address - Country:US
Practice Address - Phone:770-914-7748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-27
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist