Provider Demographics
NPI:1619579554
Name:NATURE GREEN LEAF
Entity Type:Organization
Organization Name:NATURE GREEN LEAF
Other - Org Name:NATURE GREEN LEAF PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:O
Authorized Official - Last Name:OJEVWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-617-7438
Mailing Address - Street 1:12568 BROADWAY ST STE 120
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8968
Mailing Address - Country:US
Mailing Address - Phone:281-617-7438
Mailing Address - Fax:281-617-1867
Practice Address - Street 1:12568 BROADWAY ST STE 120
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8968
Practice Address - Country:US
Practice Address - Phone:281-617-7438
Practice Address - Fax:281-617-1867
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATURE GREEN LEAF
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-16
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX691104Medicaid