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Organization
EVERGREEN PARK PHARMACY INC
Active
Organization
EVERGREEN PARK PHARMACY INC
Active
Other names
Evergreen Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
HANI ABDALLAH (PHARMACY MANAGER)
(708) 423-4700
Entity
Organization
Contact information
Practice address
2850 W 95TH ST, STE 100, EVERGREEN PARK, IL 60805-2735
(708) 423-4700
(708) 423-4720
Mailing address
2850 W 95TH ST, STE 100, EVERGREEN PARK, IL 60805-2735
(708) 423-4700
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
054016406
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2116967
PK
—
Enumeration date
08/20/2008
Last updated
12/01/2016
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