Provider Demographics
NPI:1043508179
Name:EHS, INC.
Entity Type:Organization
Organization Name:EHS, INC.
Other - Org Name:THE PHARMACY AT EVERGREEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AVP OF REVENUE CYCLE MGMT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:STACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-880-7399
Mailing Address - Street 1:206 SOUTH ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201
Mailing Address - Country:US
Mailing Address - Phone:716-541-0656
Mailing Address - Fax:716-541-0661
Practice Address - Street 1:206 SOUTH ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201
Practice Address - Country:US
Practice Address - Phone:716-541-0656
Practice Address - Fax:716-541-0661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-11
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0307233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03370596Medicaid
2131014OtherPK