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  5. Green Line Apothecary of Providence LLC

Green Line Apothecary of Providence LLC

Company Details

Name: Green Line Apothecary of Providence LLC
Jurisdiction: Rhode Island
Entity type: Domestic Limited Liability Company
Status: Activ
Date of Organization in Rhode Island: 21 Aug 2018 (6 years ago)
Identification Number: 001687513
ZIP code: 02904
County: Providence County
Principal Address: 905 N MAIN ST, PROVIDENCE, RI, 02904, USA
Mailing Address: 245 MAIN ST, WAKEFIELD, RI, 02879, USA
Purpose: PHARMACY AND SODA FOUNTAIN
NAICS: 446110 - Pharmacies and Drug Stores

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1750862983 2018-08-26 2023-09-15 245 MAIN ST, WAKEFIELD, RI, 028793527, US 905 N MAIN ST, PROVIDENCE, RI, 029045744, US

Contacts
Phone +1 401-360-3200
Phone +1 401-633-8100

Authorized person
Name CHRISTINA PROCACCIANTI
Role CEO
Phone 4013603200

Taxonomy
Taxonomy Code 3336C0003X - Community/Retail Pharmacy
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
GREEN LINE APOTHECARY OF PROVIDENCE 401(K) PLAN 2023 831654989 2024-11-08 GREEN LINE APOTHECARY OF PROVIDENCE, LLC 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 446110
Sponsor’s telephone number 4013603200
Plan sponsor’s address 245 MAIN STREET, WAKEFIELD, RI, 02879

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2024-11-08
Name of individual signing QIAN LIU
Valid signature Filed with authorized/valid electronic signature
GREEN LINE APOTHECARY OF PROVIDENCE 401(K) PLAN 2023 831654989 2024-05-21 GREEN LINE APOTHECARY OF PROVIDENCE, LLC 35
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 446110
Sponsor’s telephone number 4013603200
Plan sponsor’s address 245 MAIN STREET, WAKEFIELD, RI, 02879

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2024-05-21
Name of individual signing QIAN LIU
Valid signature Filed with authorized/valid electronic signature
GREEN LINE APOTHECARY OF PROVIDENCE 401(K) PLAN 2022 831654989 2023-05-27 GREEN LINE APOTHECARY OF PROVIDENCE, LLC 52
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 446110
Sponsor’s telephone number 4013603200
Plan sponsor’s address 245 MAIN STREET, WAKEFIELD, RI, 02879

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2023-05-26
Name of individual signing CHRISTINE RIMER
Valid signature Filed with authorized/valid electronic signature
GREEN LINE APOTHECARY OF PROVIDENCE 401(K) PLAN 2021 831654989 2022-05-19 GREEN LINE APOTHECARY OF PROVIDENCE, LLC 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 446110
Sponsor’s telephone number 4013603200
Plan sponsor’s address 245 MAIN STREET, WAKEFIELD, RI, 02879

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1645 E 6TH STREET, SUITE 200, AUSTIN, TX, 78702
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2022-05-19
Name of individual signing CHRISTINE RIMER
Valid signature Filed with authorized/valid electronic signature
GREEN LINE APOTHECARY OF PROVIDENCE 401(K) PLAN 2020 831654989 2021-07-16 GREEN LINE APOTHECARY OF PROVIDENCE, LLC 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 446110
Sponsor’s telephone number 4019329626
Plan sponsor’s address 41 WINTER STREET, WAKEFIELD, RI, 02879

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2021-07-15
Name of individual signing CAROL HO
Valid signature Filed with authorized/valid electronic signature
GREEN LINE APOTHECARY OF PROVIDENCE 401(K) PLAN 2019 831654989 2020-05-26 GREEN LINE APOTHECARY OF PROVIDENCE, LLC 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 446110
Sponsor’s telephone number 4019329626
Plan sponsor’s address 41 WINTER STREET, WAKEFIELD, RI, 02879

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2020-05-26
Name of individual signing CAROL HO
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
KENNETH PROCACCIANTI Agent 245 MAIN ST, WAKEFIELD, RI, 02879, USA

Filings

Number Name File Date
202449290170 Annual Report 2024-03-25
202327438580 Annual Report 2023-02-03
202220807960 Annual Report 2022-07-07
202219440800 Revocation Notice For Failure to File An Annual Report 2022-06-22
202101687720 Annual Report 2021-09-17
202101687540 Statement of Change of Registered/Resident Agent Office 2021-09-17
202071503480 Annual Report 2020-11-04
201924450050 Annual Report 2019-10-17
201875155860 Articles of Organization 2018-08-21

Related by officers

KENNETH PROCACCIANTI

203 MAIN LLC Lineage LLC 905 North Main LLC Town Made LLC 245 Main St, LLC Green Line Express LLC Green Line Supply LLC Linea Verde LLC

Related by address

245 MAIN ST, WAKEFIELD, RI, 02879, USA

905 North Main LLC 245 Main St, LLC Green Line Express LLC Green Line Supply LLC

Date of last update: 27 Oct 2024

Sources: Rhode Island Department of State

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