Evergreen Pharmacy, Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

0201004585 Issued in VA

Legal business name

EVERGREEN PHARMACY, INC

Doing business as

Annandale Pharmacy

Practice address

7006 Little River Tpke Ste B
Annandale, VA 22003-3218

Phone

(703) 992-8806

Fax

(703) 992-8805

NPI assigned

Jul 17, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Jee Eun Kim, PHARMD., RPH.

Title

Owner

Phone

(703) 825-1860

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• ANNANDALE PHARMACY Doing business as

Locations

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

{
    "created_epoch": "1405555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544400000000",
    "number": "1427465806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7006 LITTLE RIVER TPKE STE B",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220033218",
            "telephone_number": "703-992-8806",
            "fax_number": "703-992-8805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7006 LITTLE RIVER TPKE STE B",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220033218",
            "telephone_number": "703-992-8806",
            "fax_number": "703-992-8805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PHARMACY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-17",
        "last_updated": "2018-12-10",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "JEE EUN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-825-1860",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD., RPH."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "VA",
            "license": "0201004585",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2146888",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ANNANDALE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ANNANDALE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Esteemcare, Inc
• Evenbeam Neuropalliative Care, LLC
• Evergreen Foot and Ankle LLC
• Evergreen Health Care Management LLC
• Evergreen OB/GYN P.C.
• Exeeda Wellness LLC
• Ez Health, Inc.
• Oluwole Olubunmi Fadahunsi, DMD
• Fair Ridge Orthopedics, Inc
• Fairfax Child and Family Therapy LLC

• Community/Retail Pharmacy in Annandale, VA
• Providers in Annandale, VA by specialty
• Community/Retail Pharmacy in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2018; 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.