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General NPI Number Information
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NPI Number | 1649092032
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Entity Type | Organization
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Legal Business Name | GREENLEAF PHARMACY LLC LTC
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 1558 COMMONWEALTH AVE
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City | BRIGHTON
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State | MA
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Zip | 02135-5033
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Country | US
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Telephone | 617-566-2281
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Fax | 617-232-4084
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Provider Business Mailing Address
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Address Line | 1558 COMMONWEALTH AVE
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City | BRIGHTON
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State | MA
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Zip | 02135-5033
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Country | US
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Telephone | 617-566-2281
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Fax | 617-232-4084
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Authorized Official
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Title or Position | PHARMACIST/CO-OWNER
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Name | UYEN LE-KONG
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Credential | PHARMD
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Telephone | 617-566-2281
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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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