Provider Demographics
NPI:1356218333
Name:GREEN WELLNESS RX LLC
Entity type:Organization
Organization Name:GREEN WELLNESS RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:706-825-8182
Mailing Address - Street 1:3479 LILY MAGNOLIA CT
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-3858
Mailing Address - Country:US
Mailing Address - Phone:706-825-8182
Mailing Address - Fax:
Practice Address - Street 1:1500 PEACHTREE INDUSTRIAL BLVD STE 140
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8489
Practice Address - Country:US
Practice Address - Phone:706-825-8182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-22
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy