Provider Demographics
NPI:1285398099
Name:GREENLEAF PHARMACY LLC
Entity type:Organization
Organization Name:GREENLEAF PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PARAG
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-616-7285
Mailing Address - Street 1:3483 S EASTERN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3314
Mailing Address - Country:US
Mailing Address - Phone:419-408-8840
Mailing Address - Fax:855-928-5544
Practice Address - Street 1:3483 S EASTERN AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3314
Practice Address - Country:US
Practice Address - Phone:725-254-3210
Practice Address - Fax:725-254-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-27
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy