Healthcare Provider Details

I. General information

NPI: 1699762617
Provider Name (Legal Business Name): GREENE VAN PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 GREENE AVE
BROOKLYN NY
11238-1011
US

IV. Provider business mailing address

94 GREENE AVE
BROOKLYN NY
11238-1011
US

V. Phone/Fax

Practice location:
  • Phone: 718-783-0890
  • Fax: 718-783-0893
Mailing address:
  • Phone: 718-783-0890
  • Fax: 718-783-0893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number023322
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NAVEEN PARUPALLI
Title or Position: VICE-PRESIDENT
Credential:
Phone: 718-783-0890