Organization
MIRANDA GREEN
Active
Other names
GREENS PRESCRIPTION CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MIRANDA GREEN PD (OWNER)
(918) 653-4803
Entity
Organization
Contact information
Practice address
101 W AVENUE D, HEAVENER, OK 74937-3017
(918) 653-4803
(918) 653-3520
Mailing address
101 W AVENUE D, HEAVENER, OK 74937-3017
(918) 653-4803
(918) 653-3520
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
19-5501
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100234100
—
OK
01
—
2072800
PK
—
Enumeration date
02/12/2007
Last updated
11/18/2015
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