Provider Demographics
NPI:1992523328
Name:GREENE PHARMA LLC
Entity type:Organization
Organization Name:GREENE PHARMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAVINDER
Authorized Official - Middle Name:RAO
Authorized Official - Last Name:ANNAMANENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-943-1715
Mailing Address - Street 1:159 JEFFERSON HTS STE D102
Mailing Address - Street 2:
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-1204
Mailing Address - Country:US
Mailing Address - Phone:518-943-1715
Mailing Address - Fax:518-943-4816
Practice Address - Street 1:159 JEFFERSON HTS STE D102
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-1204
Practice Address - Country:US
Practice Address - Phone:518-943-1715
Practice Address - Fax:518-943-4816
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENE PHARMA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy