Organization
EVERGREEN PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN DANG RPH (PRESIDENT,PIC, AO)
(408) 391-0700
Entity
Organization
Contact information
Practice address
2365 QUIMBY RD STE 150, SAN JOSE, CA 95122-1337
(408) 531-9961
(855) 831-7973
Mailing address
EVERGREEN PHARMACY, PO BOX 731582, SAN JOSE, CA 95173-1582
(408) 531-9961
(855) 831-7973
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY51198
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2158376
PK
—
Enumeration date
03/02/2016
Last updated
06/06/2018
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