Healthcare Provider Details

I. General information

NPI: 1760206197
Provider Name (Legal Business Name): EVERGREEN FUNCTIONAL MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W GARLAND AVE STE C
SPOKANE WA
99205-2649
US

IV. Provider business mailing address

1717 W GARLAND AVE STE C
SPOKANE WA
99205-2649
US

V. Phone/Fax

Practice location:
  • Phone: 509-720-6314
  • Fax: 509-278-9266
Mailing address:
  • Phone: 509-720-6314
  • Fax: 509-278-9266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL A MILANI
Title or Position: OWNER P
Credential: PHARMD
Phone: 509-720-6314