Provider Demographics
NPI:1699762617
Name:GREENE VAN PHARMACY CORP
Entity type:Organization
Organization Name:GREENE VAN PHARMACY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARUPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-783-0890
Mailing Address - Street 1:94 GREENE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-1011
Mailing Address - Country:US
Mailing Address - Phone:718-783-0890
Mailing Address - Fax:718-783-0893
Practice Address - Street 1:94 GREENE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-1011
Practice Address - Country:US
Practice Address - Phone:718-783-0890
Practice Address - Fax:718-783-0893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
NY0233223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01813432Medicaid
2064159OtherPK
4508680001Medicare NSC