Organization
EVERS RX INC
Active
Other names
BOOM Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DAVE WATTS PHARM D (VICE PRESIDENT)
(718) 292-0900
Entity
Organization
Contact information
Practice address
226 E 144TH ST FL 2, BRONX, NY 10451-5909
(718) 292-0900
(718) 292-0909
Mailing address
226 E 144TH ST FL 2, BRONX, NY 10451-5909
(718) 292-0900
(718) 292-0909
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
031260
NY
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03457196
—
NY
01
—
2134434
PK
—
Enumeration date
03/28/2012
Last updated
12/04/2024
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