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General NPI Number Information
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NPI Number | 1366518466
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Entity Type | Organization
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Legal Business Name | GREEN TREE PHARMACIES LLC
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 02/16/2017
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Provider Practice Location Address
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Address Line | 240 W PINE ST
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City | PONCHATOULA
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State | LA
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Zip | 70454-3311
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Country | US
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Telephone | 985-386-8543
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Fax | 985-386-0786
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Provider Business Mailing Address
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Address Line | 240 W PINE ST
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City | PONCHATOULA
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State | LA
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Zip | 70454-3311
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Country | US
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Telephone | 985-386-8543
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Fax | 985-386-0786
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JIMMY NEIL
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Credential |
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Telephone | 985-386-6550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY.006647-IR
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License Number State | LA
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