Green Leaf Dispensary LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

GREEN LEAF DISPENSARY LLC

Practice address

6048 W Park Ave
Houma, LA 70364-1808

Phone

(985) 360-3372

Fax

(985) 709-0435

NPI assigned

Nov 1, 2019

Organization subpart

No

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

Authorized official

Name

Omar Pecantte

Title

President

Phone

(985) 360-3372

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1572566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572566400000",
    "number": "1477197531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 782",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703610782",
            "telephone_number": "985-360-3372",
            "fax_number": "985-709-0435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6048 W PARK AVE",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703641808",
            "telephone_number": "985-360-3372",
            "fax_number": "985-709-0435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN LEAF DISPENSARY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-01",
        "last_updated": "2019-11-01",
        "status": "A",
        "authorized_official_last_name": "PECANTTE",
        "authorized_official_first_name": "OMAR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "985-360-3372"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "HOUMA",
            "affiliation": "N",
            "endpointDescription": "Pharmacy",
            "address_1": "6048 W Park Ave",
            "city": "Houma",
            "state": "LA",
            "country_code": "US",
            "postal_code": "703641808",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Dayreion Gray
• Jason De-Leon Gray, RN
• Jeremiah Gray
• Joseph Hunter Gray, PT, DPT
• Teranasia Keorra Gray
• Gregory C. Maidoh, MD, Inc.
• Gregory Zeringue Or Rachel Beyer Special Account
• James Robert Gregory, DC
• Susan V Gremillion, CRNA
• Russell Griffin, CRNA

• Community/Retail Pharmacy in Houma, LA
• Providers in Houma, LA by specialty
• Community/Retail Pharmacy in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2019; 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.