# GREEN LEAF DISPENSARY LLC

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

## Provider details

- **NPI number:** 1477197531
- **Authorized official:** OMAR PECANTTE (PRESIDENT)
- **Authorized official phone:** (985) 360-3372

## Contact information

- **Practice address:** 6048 W PARK AVE, HOUMA, LA 70364-1808
- **Practice address phone:** (985) 360-3372
- **Practice address fax:** (985) 709-0435
- **Mailing address:** PO BOX 782, HOUMA, LA 70361-0782
- **Mailing address phone:** (985) 360-3372
- **Mailing address fax:** (985) 709-0435

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 11/01/2019
- **Last updated:** 11/01/2019