# GREEN LINE SUPPLY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386450153
- **Authorized official:** KENNETH PROCACCIANTI (PRESIDENT)
- **Authorized official phone:** (401) 360-3200

## Contact information

- **Practice address:** 10 TRIPPS LN, RIVERSIDE, RI 02915-3014
- **Practice address phone:** (401) 360-3400
- **Mailing address:** 203 MAIN ST, WAKEFIELD, RI 02879-3557

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 12/06/2024
- **Last updated:** 12/06/2024