Organization
EVERGREEN PHARMACY INC
Active
Other names
EVERGREEN PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
AUGUSTINE ORANUSI (OWNED/PHARMACIST)
(954) 478-2950
Entity
Organization
Contact information
Practice address
875 E 10TH AVE, HIALEAH, FL 33010-4645
(786) 360-4945
(786) 360-4955
Mailing address
875 E 10TH AVE, HIALEAH, FL 33010-4645
(786) 360-4945
(786) 360-4955
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH26138
FL
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008565300
—
FL
01
—
2137257
PK
—
Enumeration date
05/14/2012
Last updated
02/20/2017
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