Provider Demographics
NPI:1699868026
Name:GREENLEAF PHARMACY LLC
Entity type:Organization
Organization Name:GREENLEAF PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SAISATISH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-478-0004
Mailing Address - Street 1:544 WARBURTON AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10706-1549
Mailing Address - Country:US
Mailing Address - Phone:914-478-0004
Mailing Address - Fax:914-478-1220
Practice Address - Street 1:544 WARBURTON AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10706-1549
Practice Address - Country:US
Practice Address - Phone:914-478-0004
Practice Address - Fax:914-478-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0317713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2142198OtherPK