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General NPI Number Information
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NPI Number | 1437067030
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Entity Type | Organization
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Legal Business Name | EVERGREEN EQUIPMENT SUPPLIES LLC
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Dates
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Enumeration Date | 09/01/2026
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Last Update Date | 09/06/2026
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Provider Practice Location Address
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Address Line | 12714 NETTLECREEK PL
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City | WOODBRIDGE
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State | VA
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Zip | 22192-8003
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Country | US
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Telephone | 737-305-6291
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Fax | 737-305-8734
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Provider Business Mailing Address
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Address Line | 12714 NETTLECREEK PL
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City | WOODBRIDGE
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State | VA
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Zip | 22192-8003
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Country | US
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Telephone | 737-305-6291
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Fax | 737-305-8734
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Authorized Official
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Title or Position | CEO
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Name | BAREERA SADIQ
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Credential |
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Telephone | 737-305-6291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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