Evergreen Park Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

054016406 Issued in IL

Legal business name

EVERGREEN PARK PHARMACY INC

Doing business as

Evergreen Pharmacy

Practice address

2850 W 95TH St
Ste 100
Evergreen Park, IL 60805-2735

Phone

(708) 423-4700

Fax

(708) 423-4720

NPI assigned

Aug 20, 2008

Organization subpart

No

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

Authorized official

Name

Hani Abdallah

Title

Pharmacy Manager

Phone

(708) 423-4700

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Evergreen Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1219190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480550400000",
    "number": "1427205574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2850 W 95TH ST",
            "address_2": "STE 100",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052735",
            "telephone_number": "708-423-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2850 W 95TH ST",
            "address_2": "STE 100",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052735",
            "telephone_number": "708-423-4700",
            "fax_number": "708-423-4720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PARK PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-20",
        "last_updated": "2016-12-01",
        "status": "A",
        "authorized_official_last_name": "ABDALLAH",
        "authorized_official_first_name": "HANI",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "708-423-4700"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054016406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2116967",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Melissa K Ewa, DDS

• Community/Retail Pharmacy in Evergreen Park, IL
• Providers in Evergreen Park, IL by specialty
• Community/Retail Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 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.