Provider Demographics
NPI:1437509361
Name:GREENPOINT PHARMACY GROUP LLC
Entity Type:Organization
Organization Name:GREENPOINT PHARMACY GROUP LLC
Other - Org Name:GREENPOINT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-557-2200
Mailing Address - Street 1:23303 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3758
Mailing Address - Country:US
Mailing Address - Phone:248-557-2200
Mailing Address - Fax:248-557-2205
Practice Address - Street 1:23303 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3758
Practice Address - Country:US
Practice Address - Phone:248-557-2200
Practice Address - Fax:248-557-2205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
MI53010109653336C0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160715OtherPK
MI2382214Medicaid