Individual
MR. JUSTIN S GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPH
Contact information
Practice address
315 N 193RD EAST AVE, CATOOSA, OK 74015-2862
(918) 266-8837
(918) 266-1512
Mailing address
315 N 193RD EAST AVE, CATOOSA, OK 74015-2862
(918) 266-8837
(918) 266-1512
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
12013
OK
Other
Enumeration date
09/19/2011
Last updated
09/19/2011
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