Healthcare Provider Details

I. General information

NPI: 1063369148
Provider Name (Legal Business Name): GREEN FIELD TRADING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 PAMELA LN APT 9
CHICAGO RIDGE IL
60415-1860
US

IV. Provider business mailing address

6440 PAMELA LN APT 9
CHICAGO RIDGE IL
60415-1860
US

V. Phone/Fax

Practice location:
  • Phone: 708-677-9286
  • Fax:
Mailing address:
  • Phone: 708-677-9286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: OMAR ALBASIOMI
Title or Position: MANAGER
Credential:
Phone: 708-677-9286