Provider Demographics
NPI:1790380327
Name:GREENLEAF, E BENJAMIN (RPH)
Entity Type:Individual
Prefix:
First Name:E BENJAMIN
Middle Name:
Last Name:GREENLEAF
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 ALEWIFE BROOK PKWY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1101
Mailing Address - Country:US
Mailing Address - Phone:617-661-6422
Mailing Address - Fax:
Practice Address - Street 1:215 ALEWIFE BROOK PKWY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1101
Practice Address - Country:US
Practice Address - Phone:617-661-6422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH254611835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist