Green Line Apothecary of Providence LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

GREEN LINE APOTHECARY OF PROVIDENCE LLC

Doing business as

Green Line Apothecary

Practice address

905 N Main St
Providence, RI 02904-5744

Phone

(401) 633-8100

NPI assigned

Aug 26, 2018

Organization subpart

No

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

Authorized official

Name

Christina Procaccianti, PHARMD

Title

Ceo

Phone

(401) 360-3200

Specialties & licenses 1

Addresses

Other names 1

• Green Line Apothecary Doing business as

Medicare fee-for-service enrollment

Enrolled in RI

Enrollment records 1

Locations

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

{
    "created_epoch": "1535241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694736000000",
    "number": "1750862983",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 N MAIN ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029045744",
            "telephone_number": "401-633-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN LINE APOTHECARY OF PROVIDENCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-26",
        "last_updated": "2023-09-15",
        "certification_date": "2023-09-15",
        "status": "A",
        "authorized_official_last_name": "PROCACCIANTI",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "401-360-3200",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Green Line Apothecary",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Greater Providence Chapter,Riarc
• Greater Providence Young Men'S Christian Association
• Wesley Greaves
• Kerra Grednuk
• Green Leaf Counseling, LLC
• Andrew Green, M.D.
• Christine Green, MS
• Jay Brian Green, OTR/L
• Marsha Ann Green, PT
• Benjamin David Greenberg, MD, PHD

• Community/Retail Pharmacy in Providence, RI
• Providers in Providence, 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 15, 2023; 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.