Organization
GREEN LEAF DISPENSARY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OMAR PECANTTE (PRESIDENT)
(985) 360-3372
Entity
Organization
Contact information
Practice address
6048 W PARK AVE, HOUMA, LA 70364-1808
(985) 360-3372
(985) 709-0435
Mailing address
PO BOX 782, HOUMA, LA 70361-0782
(985) 360-3372
(985) 709-0435
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
11/01/2019
Last updated
11/01/2019
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