<Unavail>

LBN: Evergreen Shop Pharmacy Inc
<Unavail> is an health care organization with primary practice located at 150 S Grand Ave Ste K , Glendora CA 91741-4715. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Evergreen Shop Pharmacy Inc can be contacted via phone (626) 335-2442, or through Kest, Manal via phone (310) 866-3415.

Contact Information

Primary practice address
150 S Grand Ave Ste K Glendora CA 91741-4715
Phone: (626) 335-2442
Fax: (626) 335-0220
Website:
Map and Directions
Authorized official contact:
Name: Kest, Manal
Phone: (310) 866-3415

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X 54456 California

Profile Details

NPI number 1083067995
LBN Legal business name Evergreen Shop Pharmacy Inc
DBA Doing business as <Unavail>
Authorized official Kest, Manal
Entity Organization
Organization subpart 1 No
Enumeration date Jul 14th, 2016
Last updated Aug 10th, 2016 - about 10 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 1083067995 NPPES
Other 2162500 PK

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