Organization
EVERGREEN PHARMACY, INC
Active
Other names
ANNANDALE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEE EUN KIM PHARMD., RPH. (OWNER)
(703) 825-1860
Entity
Organization
Contact information
Practice address
7006 LITTLE RIVER TPKE STE B, ANNANDALE, VA 22003-3218
(703) 992-8806
(703) 992-8805
Mailing address
7006 LITTLE RIVER TPKE STE B, ANNANDALE, VA 22003-3218
(703) 992-8806
(703) 992-8805
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
0201004585
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2146888
PK
—
Enumeration date
07/17/2014
Last updated
12/10/2018
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