Gayla Greene

Primary specialty

PharmacistTaxonomy code 183500000X

License

051036441 Issued in IL

Practice address

245 W 1St Dr
Decatur, IL 62521-5299

Phone

(217) 429-5165

Fax

(217) 429-5172

NPI assigned

Jan 12, 2021

Last updated

Jan 12, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lake of Decatur Inc

  dba Dales Southlake Pharmacy

  • Community/Retail Pharmacy
  • Decatur, IL
  • NPI 1588613384
  NPD (past)

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

{
    "created_epoch": "1610409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610409600000",
    "number": "1720677933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 MAXWELL ST",
            "city": "TAYLORVILLE",
            "state": "IL",
            "postal_code": "625681231",
            "telephone_number": "217-273-9697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 W 1ST DR",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625215299",
            "telephone_number": "217-429-5165",
            "fax_number": "217-429-5172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENE",
        "first_name": "GAYLA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-12",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051036441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary G Gray, O.D.
• Hannah Suzanne Gray, AU.D.
• Amber N Green
• Tarsheka Green, PMHNP-BC
• Teresa Green, LPN
• Cheyanna Gregg, RBT
• Gregory L. Totel, M.D.,S.C.
• Susan Elizabeth Griffin, FNP
• Sydney Grohler, FNP-C
• Kristen Lee Grohne, SLP

• Pharmacist in Decatur, IL
• Providers in Decatur, IL by specialty
• Pharmacist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2021; 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.