Green Line Apothecary LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHA00608 Issued in RI

Legal business name

GREEN LINE APOTHECARY LLC

Doing business as

Green Line Apothecary

Practice address

245 Main St
Wakefield, RI 02879-3527

Phone

(401) 360-3300

Fax

(401) 783-0045

NPI assigned

Dec 11, 2015

Last updated

Sep 10, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Christina Procaccianti, PHARMDNPI 1609042407

Title

Owner, Pic, Ao

Phone

(401) 360-3200

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Green Line Apothecary Doing business as

Medicare fee-for-service enrollment

Enrolled in RI

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Christina Procaccianti, PHARMD

  • Pharmacist
  • Wakefield, RI
  • NPI 1609042407
  NPD (past) Authorized official
• Ryan Patrick Kelley, PHARMD

  • Pharmacist
  • Wakefield, RI
  • NPI 1003306382
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1449792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631232000000",
    "number": "1023483336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 MAIN ST",
            "city": "WAKEFIELD",
            "state": "RI",
            "postal_code": "028793527",
            "telephone_number": "401-360-3200",
            "fax_number": "401-783-0045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 MAIN ST",
            "city": "WAKEFIELD",
            "state": "RI",
            "postal_code": "028793527",
            "telephone_number": "401-360-3300",
            "fax_number": "401-783-0045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN LINE APOTHECARY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-11",
        "last_updated": "2021-09-10",
        "certification_date": "2021-09-10",
        "status": "A",
        "authorized_official_last_name": "PROCACCIANTI",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "OWNER, PIC, AO",
        "authorized_official_telephone_number": "401-360-3200",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "RI",
            "license": "PHA00608",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2156025",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Green Line Apothecary",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Green Line Apothecary",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jean Paul Gottret Merkel, M.D.
• Chelsea Erin Graham, D.O.
• John D Graham, MD
• Heather Mae Grant, PHARM.D.
• Patricia F Graves, LICSW
• Green Line Apothecary LLC
• Green Line Express LLC
• Terese Tanski Gregg, LICSW
• James Francis Griffin, D.O.
• Patricia Ann Grimes

• Community/Retail Pharmacy in Wakefield, RI
• Providers in Wakefield, RI by specialty
• Community/Retail Pharmacy in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.