<Unavail>

LBN: Evergreen Pharmacy, Inc
<Unavail> is an health care organization with primary practice located at 7 Broad Ave Ste 105 , Palisades Park NJ 07650-1886. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Pharmacy is the primary health care specialty. Evergreen Pharmacy, Inc can be contacted via phone (201) 941-1111, or through Cho, Yongsun via phone (201) 941-1111.

Contact Information

Primary practice address
7 Broad Ave Ste 105 Palisades Park NJ 07650-1886
Phone: (201) 941-1111
Fax: (201) 941-1124
Website:
Map and Directions
Authorized official contact:
Name: Cho, Yongsun
Phone: (201) 941-1111

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X 28RS00761800 New Jersey
Suppliers / Community/Retail Pharmacy 3336C0003X

Profile Details

NPI number 1083122949
LBN Legal business name Evergreen Pharmacy, Inc
DBA Doing business as <Unavail>
Authorized official Cho, Yongsun
Entity Organization
Organization subpart 1 No
Enumeration date Jan 12th, 2018
Last updated Jul 19th, 2018 - about 8 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083122949 NPPES
Other 2176951 PK
MEDICAID 0619353 PK

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