Provider Demographics
NPI:1851658736
Name:GREENE PHARMA LLC
Entity Type:Organization
Organization Name:GREENE PHARMA LLC
Other - Org Name:GREENE MEDICAL ARTS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER / PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:
Authorized Official - Last Name:VELESETTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-943-1715
Mailing Address - Street 1:159 JEFFERSON HEIGHTS
Mailing Address - Street 2:SUITE D102
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-1239
Mailing Address - Country:US
Mailing Address - Phone:518-943-1715
Mailing Address - Fax:518-943-4816
Practice Address - Street 1:159 JEFFERSON HTS STE D102
Practice Address - Street 2:SUITE D102
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-1204
Practice Address - Country:US
Practice Address - Phone:518-943-1715
Practice Address - Fax:518-943-4816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0313693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03460524Medicaid
2136245OtherPK
NY03460524OtherNY MEDICAID
NYFG3349342OtherDEA
NYFG3349342OtherDEA