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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 Specialty Code Provider Type

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
 

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for EVERGREEN PHARMACY, INC.

NPI Number 1083122949
LBN Legal business name EVERGREEN PHARMACY, INC.
Authorized official YONGSUN CHO - (MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 01/12/2018
Last updated 07/19/2018 - About 8 years ago
Identifiers
NJ License # 28RS00761800
NJ Medicaid 0619353
Other 2176951 PK
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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