Green Brothers Pharmacy, Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY17863 Issued in CA

Legal business name

GREEN BROTHERS PHARMACY, INC

Doing business as

Green Brothers Pharmacy Inc

Practice address

1617 N California St
Stockton, CA 95204-6117

Phone

(209) 948-6435

Fax

(209) 235-0241

NPI assigned

Jun 30, 2006

Last updated

Apr 15, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Edward Rogan, PHARM.D.NPI 1487665295

Title

Manager

Phone

(209) 948-6435

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• GREEN BROTHERS PHARMACY INC Doing business as

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Edward Lionel Rogan, PHARM. D.

  • Pharmacist
  • Stockton, CA
  • NPI 1487665295
  NPD (past) Authorized official
• Marisella Guerrero, PHARM D

  • Pharmacist
  • Stockton, CA
  • NPI 1336150044
  NPD (past)
• William A. Kehoe, PHARM.D.

  • Pharmacist
  • Stockton, CA
  • NPI 1669483780
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302825600000",
    "number": "1619905221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1617 N CALIFORNIA ST",
            "address_2": "SUITE 1-F",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952046117",
            "telephone_number": "209-948-6435",
            "fax_number": "209-235-0241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1617 N CALIFORNIA ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952046117",
            "telephone_number": "209-948-6435",
            "fax_number": "209-235-0241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN BROTHERS PHARMACY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-30",
        "last_updated": "2011-04-15",
        "status": "A",
        "authorized_official_last_name": "ROGAN",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "209-948-6435",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY17863",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0526915",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA178630",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GREEN BROTHERS PHARMACY INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nawana Miesa Gray, OWNER/GENERAL MANAGE
• Nicole Gray
• Serena Gray
• David Grayson, MFT- I
• Green Brothers Pharmacy Inc (Green Brothers Pharmacy)
• Kayla Green Tatum
• Aliyah Green
• Brianna Renee Green
• Charles Rowand Green, R.PH.
• Phyllis Louise Green

• Community/Retail Pharmacy in Stockton, CA
• Providers in Stockton, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.