# EVERGREEN PARK PHARMACY INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Evergreen Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427205574
- **Authorized official:** HANI ABDALLAH (PHARMACY MANAGER)
- **Authorized official phone:** (708) 423-4700

## Contact information

- **Practice address:** 2850 W 95TH ST, STE 100, EVERGREEN PARK, IL 60805-2735
- **Practice address phone:** (708) 423-4700
- **Practice address fax:** (708) 423-4720
- **Mailing address:** 2850 W 95TH ST, STE 100, EVERGREEN PARK, IL 60805-2735
- **Mailing address phone:** (708) 423-4700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054016406 | IL | Yes |

## Other

- **Enumeration date:** 08/20/2008
- **Last updated:** 12/01/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2116967 | PK | — |