Healthcare Provider Details

I. General information

NPI: 1124934807
Provider Name (Legal Business Name): GREENLEAF COMPOUNDING PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2612 HOLCOMB BRIDGE RD STE 110
ALPHARETTA GA
30022-5494
US

IV. Provider business mailing address

2612 HOLCOMB BRIDGE RD STE 110
ALPHARETTA GA
30022-5494
US

V. Phone/Fax

Practice location:
  • Phone: 770-744-2461
  • Fax:
Mailing address:
  • Phone: 770-744-2461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. SAUDAT MAWIA
Title or Position: OWNER
Credential: PHARM D
Phone: 404-934-1691