Organization
EVERGREEN FUNCTIONAL MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JANE COX (ADMINISTRATOR/ACCESS MANAGER)
(949) 664-2796
Entity
Organization
Contact information
Practice address
607 W WILLAPA AVE, SPOKANE, WA 99224-5337
(509) 720-6314
Mailing address
607 W WILLAPA AVE, SPOKANE, WA 99224-5337
(509) 720-6314
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
—
—
1835N1003X
Nutrition Support Pharmacist
—
—
Other
Enumeration date
11/12/2024
Last updated
11/12/2024
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