# GREEN CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GREEN CLINIC PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275632036
- **Authorized official:** MARY CROWE RPH (PHARMACY DIRECTOR)
- **Authorized official phone:** (318) 251-6337

## Contact information

- **Practice address:** 1200 S FARMERVILLE ST, RUSTON, LA 71270-5941
- **Practice address phone:** (318) 251-6337
- **Practice address fax:** (318) 251-6334
- **Mailing address:** 1200 SOUTH FARMERVILLE STREET, RUSTON, LA 71270
- **Mailing address phone:** (318) 251-6337
- **Mailing address fax:** (318) 251-6334

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHY.005703-IR | LA | Yes |

## Other

- **Enumeration date:** 09/21/2006
- **Last updated:** 09/19/2025