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General NPI Number Information
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NPI Number | 1871605105
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Entity Type | Organization
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Legal Business Name | EVERGREEN PHARMACEUTICAL OF CALIFORNIA, LLC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 01/04/2021
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Provider Practice Location Address
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Address Line | 20967 CABOT BLVD
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City | HAYWARD
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State | CA
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Zip | 94545-1155
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Country | US
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Telephone | 510-265-0300
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Fax | 510-265-1034
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Provider Business Mailing Address
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Address Line | 1 CVS DR BOX 1075
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City | WOONSOCKET
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State | RI
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Zip | 02895-6146
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SR DIRECTOR, PAYER RELATIONS
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Name | SUSAN COLBERT
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Credential |
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Telephone | 401-770-2751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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