National Provider Identifier Database

EVERGREEN PHARMACY INC
Pharmacy

A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.


Contact Information

EVERGREEN PHARMACY, INC.
7 BROAD AVE STE 105
PALISADES PARK, NJ07650
Phone: 201-941-1111
Fax: 201-941-1124
Website:
Specialty Taxonomy Code
* Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X

* Indicates primary specialty

NPI Profile & details for EVERGREEN PHARMACY, INC.

NPI Number 1083122949
Legal business name
LBN
EVERGREEN PHARMACY, INC.
Authorized official YONGSUN CHO - (MANAGER)
Entity Organization
Organization subpart No
Enumeration date 01/12/2018
Last updated 07/19/2018 - About 8 years ago
Sole proprietor1 Not specified
Identifiers
  • NJ License #: 28RS00761800
  • NJ Medicaid: 0619353
  • Other: 2176951 PK

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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