Healthcare Provider Details

I. General information

NPI: 1487928164
Provider Name (Legal Business Name): EVERS LTC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 WHITESTONE EXPY STE 107 SUITE 107
FLUSHING NY
11354-1995
US

IV. Provider business mailing address

3050 WHITESTONE EXPY SUITE 107
FLUSHING NY
11354-1964
US

V. Phone/Fax

Practice location:
  • Phone: 718-762-7400
  • Fax: 718-762-7404
Mailing address:
  • Phone: 718-762-7400
  • Fax: 718-762-7404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number031139
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HARALAMPOS RALLAKIS
Title or Position: PRESIDENT
Credential:
Phone: 718-762-7400