Provider Demographics
NPI:1396857421
Name:EVERGREENS DRUGS INC
Entity Type:Organization
Organization Name:EVERGREENS DRUGS INC
Other - Org Name:EVERGREENS DRUGS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:702-269-1354
Mailing Address - Street 1:10001 S EASTERN AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3907
Mailing Address - Country:US
Mailing Address - Phone:702-269-1354
Mailing Address - Fax:702-269-1364
Practice Address - Street 1:10001 S EASTERN AVE
Practice Address - Street 2:STE 105
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3907
Practice Address - Country:US
Practice Address - Phone:702-269-1354
Practice Address - Fax:702-269-1364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NVPH020553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2802663Medicaid
2051532OtherPK
5445970001Medicare NSC