Green Tree Pharmacy, Inc.

Primary specialty

PharmacyTaxonomy code 333600000X

License

058-013453 Issued in IL

Legal business name

GREEN TREE PHARMACY, INC.

Doing business as

Green Tree Pharmacy

Practice address

1305 Carolyn Dr
Minonk, IL 61760

Phone

(309) 432-3451

Fax

(309) 432-2575

NPI assigned

Nov 1, 2005

Last updated

Aug 29, 2024By 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

Charles T. George, PHARMDNPI 1154386787

Title

Vice President

Phone

(309) 432-3451

Specialties & licenses 4

Addresses

Other names 1

• Green Tree Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in IL2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 10

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.

• Charles T. George, PHARMD

  • Pharmacist
  • Minonk, IL
  • NPI 1154386787
  NPD Authorized official
• Jeremy Gray, PHARMD.

  • Pharmacist
  • Minonk, IL
  • NPI 1962074013
  NPD
• Jamie Harrison, PHARMD

  • Pharmacist
  • Minonk, IL
  • NPI 1518315696
  NPD
• Mayla M Jenkins, CPHT

  • Pharmacy Technician
  • Minonk, IL
  • NPI 1649938127
  NPD
• Rebecca Bowen Reynolds, RPH

  • Geriatric Pharmacist
  • Minonk, IL
  • NPI 1457182107
  NPD
• Randall Stuerman, RPH

  • Pharmacist
  • Minonk, IL
  • NPI 1972827780
  NPD
• Ashley Lauren Yount

  • Pharmacy Technician
  • Minonk, IL
  • NPI 1053079657
  NPD
• Stephanie M Bressner, RPH

  • Pharmacist
  • Minonk, IL
  • NPI 1710993795
  NPD (past)
• Neil Paul Heineke, PHARM D.

  • Pharmacist
  • Minonk, IL
  • NPI 1033240767
  NPD (past)
• David D Wegman, RPH, MS, FASCP, CGP

  • Geriatric Pharmacist
  • Minonk, IL
  • NPI 1487958914
  NPD (past)

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

{
    "created_epoch": "1130803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724889600000",
    "number": "1245221068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 N CAROLYN DR",
            "city": "MINONK",
            "state": "IL",
            "postal_code": "617609326",
            "telephone_number": "309-432-3451",
            "fax_number": "309-829-9512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 CAROLYN DR",
            "city": "MINONK",
            "state": "IL",
            "postal_code": "61760",
            "telephone_number": "309-432-3451",
            "fax_number": "309-432-2575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN TREE PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-01",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A",
        "authorized_official_last_name": "GEORGE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "309-432-3451",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "IL",
            "license": "032-006965",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "IL",
            "license": "058-013453",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "IL",
            "license": "058-013453",
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "IL",
            "license": "058-013453",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Green Tree Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sonja Marie Frei, L.M.T.
• Tonya Renee Gensler
• Charles T. George, PHARMD
• Ann Marie Graham
• Jeremy Gray, PHARMD.
• Jamie Harrison, PHARMD
• Neil Paul Heineke, PHARM D.
• Heritage Manor - Minonk, LLC (Heritage Health)
• Heritage Manor Minonk, LLC (Heritage Health - Minonk)
• Mayla M Jenkins, CPHT

• Pharmacy in Minonk, IL
• Providers in Minonk, IL by specialty
• Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.