Provider Demographics
NPI:1679554075
Name:TOTAL HEALTH CARE, INC
Entity Type:Organization
Organization Name:TOTAL HEALTH CARE, INC
Other - Org Name:EVERGREEN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONG-HYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-886-2400
Mailing Address - Street 1:781 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-3203
Mailing Address - Country:US
Mailing Address - Phone:201-886-2400
Mailing Address - Fax:201-886-0059
Practice Address - Street 1:781 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-3203
Practice Address - Country:US
Practice Address - Phone:201-886-2400
Practice Address - Fax:201-886-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00537500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3138535OtherNCPDP NUMBER
NJ7121601Medicaid