Organization
EVERGREEN RX INC
Active
Other names
Medico Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
YURY AKOPYAN (OWNER)
(310) 444-9011
Entity
Organization
Contact information
Practice address
11779 SANTA MONICA BLVD, LOS ANGELES, CA 90025-2843
(310) 444-9011
(310) 444-0418
Mailing address
11779 SANTA MONICA BLVD, LOS ANGELES, CA 90025-2843
(310) 444-9011
(310) 444-0418
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY51906
CA
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346241700
—
CA
01
—
2151974
PK
—
Enumeration date
08/09/2005
Last updated
12/03/2024
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