Organization
GREEN TREE PHARMACIES LLC
Active
Other names
MEDITHRIFT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JIMMY NEIL (AUTHORIZED OFFICIAL)
(985) 386-6550
Entity
Organization
Contact information
Practice address
240 W PINE ST, PONCHATOULA, LA 70454-3311
(985) 386-8543
(985) 386-0786
Mailing address
240 W PINE ST, PONCHATOULA, LA 70454-3311
(985) 386-8543
(985) 386-0786
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY.006647-IR
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2140538
PK
—
05
—
2202031
—
LA
Enumeration date
11/28/2006
Last updated
02/16/2017
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