Evergreen Shop Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

54456 Issued in CA

Legal business name

EVERGREEN SHOP PHARMACY INC

Practice address

150 S Grand Ave Ste K
Glendora, CA 91741-4715

Phone

(626) 335-2442

Fax

(626) 335-0220

NPI assigned

Jul 14, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Manal Kest

Title

Corparation Officer

Phone

(310) 866-3415

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Evergreen Shop Pharmacy Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1468454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470787200000",
    "number": "1083067995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 S GRAND AVE STE K",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917414715",
            "telephone_number": "626-335-2442",
            "fax_number": "626-335-0220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 S GRAND AVE STE K",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917414715",
            "telephone_number": "626-335-2442",
            "fax_number": "626-335-0220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN SHOP PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-14",
        "last_updated": "2016-08-10",
        "status": "A",
        "authorized_official_last_name": "KEST",
        "authorized_official_first_name": "MANAL",
        "authorized_official_title_or_position": "CORPARATION OFFICER",
        "authorized_official_telephone_number": "310-866-3415"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "54456",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2162500",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Shop Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Romelda Capitly Estrada, NP
• Michal Estrela, RN
• Edgar Sunglao Evangelista, NP
• Jeri Lee Evans, B.S.
• Evergreen Natural Medicine and Acupuncture Corp.
• Brittany Everson, DPM
• Eyenez Integrated Managed Eye Care Network, a Medical Group, Inc.
• Fadda MD Inc a P C
• Falamack Zaltash D.D.S Inc.,
• Azadeh Famili, PH.D.

• Community/Retail Pharmacy in Glendora, CA
• Providers in Glendora, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.