Bryan Green, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

RPH026121 Issued in GA

Practice address

8446 Campbellton St
Douglasville, GA 30134-1803

Phone

(770) 635-8509

Fax

(770) 675-7296

NPI assigned

Dec 23, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Locations

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

• Premier Drugstore LLC

  • Community/Retail Pharmacy
  • Douglasville, GA
  • NPI 1114372448
  NPD Authorized official

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

{
    "created_epoch": "1608681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616112000000",
    "number": "1730776899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8446 CAMPBELLTON ST",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301341803",
            "telephone_number": "770-635-8509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8446 CAMPBELLTON ST",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301341803",
            "telephone_number": "770-635-8509",
            "fax_number": "770-675-7296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "BRYAN",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-23",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "RPH026121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003175653A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Grands Premier Health & Lab Diagnostics LLC
• Granger Dental Spa, PC
• Krystle Grant
• Tiffany C Grant
• Danielle Matrece Green-Watson, DPM
• Kassie Danielle Green
• Kaycee Green, ATC
• Kesha P Green, LCSW
• Mary O. Green, SOCIAL WORKER
• Nakisha Green, LMT

• Pharmacist in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Pharmacist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 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.