Provider Demographics
NPI:1659706745
Name:GREENLEAF APOTHECARY, LLC
Entity Type:Organization
Organization Name:GREENLEAF APOTHECARY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEMSARZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:317-850-8583
Mailing Address - Street 1:10154 BROOKS SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-3842
Mailing Address - Country:US
Mailing Address - Phone:317-850-8583
Mailing Address - Fax:
Practice Address - Street 1:10154 BROOKS SCHOOL RD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-3842
Practice Address - Country:US
Practice Address - Phone:317-850-8583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-07
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60006356A3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy