Organization
GREEN EARTH PHARMACY INC
Active
Other names
Green Earth Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA BORTELL (PRESIDENT/CEO)
(501) 613-3856
Entity
Organization
Contact information
Practice address
405 E 3RD ST, LITTLE ROCK, AR 72201-1611
(501) 246-3296
(501) 246-3339
Mailing address
PO BOX 2361, LITTLE ROCK, AR 72203-2361
(501) 613-3856
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR20628
AR
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0423424
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/05/2010
Last updated
10/21/2011
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