Provider Demographics
NPI:1043997364
Name:GREENLEAF PHARMACY INC
Entity Type:Organization
Organization Name:GREENLEAF PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHIRAG
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:847-346-9958
Mailing Address - Street 1:13535 LUCKY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-5127
Mailing Address - Country:US
Mailing Address - Phone:847-346-9958
Mailing Address - Fax:
Practice Address - Street 1:401 GREENLEAF ST STE 1
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:IL
Practice Address - Zip Code:60085-5744
Practice Address - Country:US
Practice Address - Phone:847-242-8267
Practice Address - Fax:847-242-8235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy