Healthcare Provider Details

I. General information

NPI: 1255838249
Provider Name (Legal Business Name): ALL GREEN PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16829 HILLSIDE AVE FL 2
JAMAICA NY
11432-4440
US

IV. Provider business mailing address

16829 HILLSIDE AVE FL 2
JAMAICA NY
11432-4440
US

V. Phone/Fax

Practice location:
  • Phone: 917-660-0413
  • Fax:
Mailing address:
  • Phone: 917-660-0413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332100000X
TaxonomyDepartment of Veterans Affairs (VA) Pharmacy
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNY

VIII. Authorized Official

Name: MUFIZUL AHAD
Title or Position: PRESIDENT
Credential:
Phone: 917-660-0413