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General NPI Number Information
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NPI Number | 1346241700
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Entity Type | Organization
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Legal Business Name | EVERGREEN RX INC
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 11779 SANTA MONICA BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90025-2843
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Country | US
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Telephone | 310-444-9011
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Fax | 310-444-0418
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Provider Business Mailing Address
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Address Line | 11779 SANTA MONICA BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90025-2843
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Country | US
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Telephone | 310-444-9011
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Fax | 310-444-0418
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Authorized Official
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Title or Position | OWNER
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Name | YURY AKOPYAN
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Credential |
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Telephone | 310-444-9011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY51906
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License Number State | CA
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