Green Leaf Pharmacy, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

GREEN LEAF PHARMACY, LLC

Practice address

201 W Boyd Dr Ste 105a
Allen, TX 75013-2512

Phone

(682) 410-0002

NPI assigned

Sep 17, 2019

Organization subpart

No

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

Authorized official

Name

Samuel Kiigi

Title

Manager

Phone

(469) 795-9060

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1568678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589932800000",
    "number": "1194375642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 W BOYD DR STE 105A",
            "city": "ALLEN",
            "state": "TX",
            "postal_code": "750132512",
            "telephone_number": "682-410-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 W BOYD DR STE 105A",
            "city": "ALLEN",
            "state": "TX",
            "postal_code": "750132512",
            "telephone_number": "682-410-0002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN LEAF PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-17",
        "last_updated": "2020-05-20",
        "certification_date": "2020-05-20",
        "status": "A",
        "authorized_official_last_name": "KIIGI",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "469-795-9060"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS STATE BOARD OF PHARMACY",
            "identifier": "32842",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Allen",
            "affiliation": "N",
            "address_1": "201 W Boyd Dr Ste 105A",
            "city": "Allen",
            "state": "TX",
            "country_code": "US",
            "postal_code": "750132512",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.