Organization
GREEN BROTHERS PHARMACY, INC
Active
Other names
GREEN BROTHERS PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD ROGAN PHARM.D. (MANAGER)
(209) 948-6435
Entity
Organization
Contact information
Practice address
1617 N CALIFORNIA ST, STOCKTON, CA 95204-6117
(209) 948-6435
(209) 235-0241
Mailing address
1617 N CALIFORNIA ST, SUITE 1-F, STOCKTON, CA 95204-6117
(209) 948-6435
(209) 235-0241
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY17863
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0526915
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA178630
—
CA
Enumeration date
06/30/2006
Last updated
04/15/2011
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