Individual
KELLY NEWTON GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
620 SHADOW LN, LAS VEGAS, NV 89106-4119
(702) 388-4700
(702) 388-4627
Mailing address
9608 ANN ARBOR LN, LAS VEGAS, NV 89134-0400
(702) 254-1093
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10331
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10331
STATE LICENSE
NV
Enumeration date
05/03/2007
Last updated
07/08/2007
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