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General NPI Number Information
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NPI Number | 1386450153
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Entity Type | Organization
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Legal Business Name | GREEN LINE SUPPLY LLC
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 10 TRIPPS LN
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City | RIVERSIDE
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State | RI
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Zip | 02915-3014
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Country | US
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Telephone | 401-360-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 203 MAIN ST
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City | WAKEFIELD
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State | RI
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Zip | 02879-3557
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNETH PROCACCIANTI
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Credential |
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Telephone | 401-360-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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