Organization
EAST ORANGE PHARMACY EVERGREEEN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIM CHIU (PHARMACIST/OWNER)
(862) 444-7188
Entity
Organization
Contact information
Practice address
60 EVERGREEN PL STE 104, EAST ORANGE, NJ 07018-2114
(862) 444-7188
(862) 444-7183
Mailing address
60 EVERGREEN PL STE 104, EAST ORANGE, NJ 07018-2114
(862) 444-7188
(862) 444-7183
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28RS00662900
BOARD OF PHARMACY
NJ
Enumeration date
03/18/2020
Last updated
03/18/2020
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