Organization
EVERGREEN PHARMACY, P.C.
Active
Other names
EVERGREEN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KWANG-SIK KIM R.PH. (OWNER)
(215) 393-0902
Entity
Organization
Contact information
Practice address
1222 WELSH RD, SUITE# C-1, NORTH WALES, PA 19454-2054
(215) 393-0902
(215) 393-0904
Mailing address
1222 WELSH RD, SUITE# C-1, NORTH WALES, PA 19454-2054
(215) 393-0902
(215) 393-0904
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PP481492
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1014115870001
—
PA
Enumeration date
02/24/2007
Last updated
08/31/2015
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