Provider Demographics
NPI:1902641376
Name:GREENLEAF PHARMACY LLC
Entity type:Organization
Organization Name:GREENLEAF PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:UYEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LE-KONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:617-566-2281
Mailing Address - Street 1:1558 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-5033
Mailing Address - Country:US
Mailing Address - Phone:617-566-2281
Mailing Address - Fax:617-232-4084
Practice Address - Street 1:1558 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-5033
Practice Address - Country:US
Practice Address - Phone:617-566-2281
Practice Address - Fax:617-232-4084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-27
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy