Individual
MELISSA D GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
500 W FORT ST, BLDG 44, BOISE, ID 83702-4501
(208) 422-1000
Mailing address
2401 S APPLE ST, A206, BOISE, ID 83706-5178
(801) 362-5628
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
6037157-1702
UT
183500000X
Pharmacist
Primary
P6563
ID
Other
Enumeration date
08/22/2011
Last updated
08/22/2011
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