Provider Demographics
NPI:1417716564
Name:GREEN LINE PHARMACY INC
Entity Type:Organization
Organization Name:GREEN LINE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUSURMON
Authorized Official - Middle Name:
Authorized Official - Last Name:NORKULOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-850-5220
Mailing Address - Street 1:8157 LEFFERTS BLVD
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1728
Mailing Address - Country:US
Mailing Address - Phone:718-850-5220
Mailing Address - Fax:718-850-5221
Practice Address - Street 1:8157 LEFFERTS BLVD
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1728
Practice Address - Country:US
Practice Address - Phone:718-850-5220
Practice Address - Fax:718-850-5221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy