Miranda Green

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

19-5501 Issued in OK

Legal business name

MIRANDA GREEN

Practice address

101 W Avenue D
Heavener, OK 74937-3017

Phone

(918) 653-4803

Fax

(918) 653-3520

NPI assigned

Feb 12, 2007

Organization subpart

No

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

Authorized official

Name

Miranda Green, PD

Title

Owner

Phone

(918) 653-4803

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• GREENS PRESCRIPTION CENTER Doing business as

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447804800000",
    "number": "1760523625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 W AVENUE D",
            "city": "HEAVENER",
            "state": "OK",
            "postal_code": "749373017",
            "telephone_number": "918-653-4803",
            "fax_number": "918-653-3520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 W AVENUE D",
            "city": "HEAVENER",
            "state": "OK",
            "postal_code": "749373017",
            "telephone_number": "918-653-4803",
            "fax_number": "918-653-3520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRANDA GREEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2015-11-18",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "MIRANDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-653-4803",
        "authorized_official_credential": "PD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OK",
            "license": "19-5501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100234100",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2072800",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GREENS PRESCRIPTION CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Makenzie Luman
• Iris Martinez
• Kristina Anne McCoy
• Trudy Leann McKinney, LCSW
• Hannah Miller
• Alexis Brianne Moody, RN BSN
• Callee Moore, APRN
• Melissa Maye Ollar
• Kevin N Poor
• Marilyn Presley, BHRS

• Community/Retail Pharmacy in Heavener, OK
• Providers in Heavener, OK by specialty
• Community/Retail Pharmacy in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2015; 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.