Organization
EVERGREEN PARK PHARMACY INC
Active
Other names
Evergreen Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
HANI ABDALLAH (PHARMACY MANAGER)
(708) 423-4700
Entity
Organization
Contact information
Practice address
2850 W 95TH ST, STE 100, EVERGREEN PARK, IL 60805-2735
(708) 423-4700
(708) 423-4720
Mailing address
2850 W 95TH ST, STE 100, EVERGREEN PARK, IL 60805-2735
(708) 423-4700
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054016406
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2116967
PK
—
Enumeration date
08/20/2008
Last updated
12/01/2016
Update your record
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