Organization
EVERGREEN PHARMACY, INC
Active
Other names
Evergreen Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
YONGSUN CHO (MANAGER)
(201) 941-1111
Entity
Organization
Contact information
Practice address
7 BROAD AVE STE 105, PALISADES PARK, NJ 07650-1886
(201) 941-1111
(201) 941-1124
Mailing address
7 BROAD AVE STE 105, PALISADES PARK, NJ 07650-1886
(201) 941-1111
(201) 941-1124
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
28RS00761800
NJ
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0619353
—
NJ
01
—
2176951
PK
—
Enumeration date
01/12/2018
Last updated
07/19/2018
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