Organization
EVERGREEN PHARMACY INC
Active
Organization
EVERGREEN PHARMACY INC
Active
Other names
EVERGREEN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN DANG PHARM.D (PRESIDENT)
(408) 270-0670
Entity
Organization
Contact information
Practice address
2690 S WHITE RD, STE 200A, SAN JOSE, CA 95148-2076
(408) 270-0670
(855) 274-7399
Mailing address
PO BOX 731556, SAN JOSE, CA 95173-1556
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
48826
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396933545
—
CA
01
—
2112962
PK
—
Enumeration date
10/11/2007
Last updated
02/28/2017
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