Organization
GREEN CLINIC LLC
Active
Other names
GREEN CLINIC PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MARY CROWE RPH (PHARMACY DIRECTOR)
(318) 251-6337
Entity
Organization
Contact information
Practice address
1200 S FARMERVILLE ST, RUSTON, LA 71270-5941
(318) 251-6337
(318) 251-6334
Mailing address
1200 SOUTH FARMERVILLE STREET, RUSTON, LA 71270
(318) 251-6337
(318) 251-6334
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY.005703-IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1234532
—
LA
01
—
2035421
PK
—
Enumeration date
09/21/2006
Last updated
09/19/2025
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