Provider Demographics
NPI:1023339454
Name:EVERS PHARMACY INC
Entity type:Organization
Organization Name:EVERS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARALAMPOS
Authorized Official - Middle Name:
Authorized Official - Last Name:RALLAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH MBA
Authorized Official - Phone:646-943-4012
Mailing Address - Street 1:14202 ROCKAWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11436-1402
Mailing Address - Country:US
Mailing Address - Phone:718-323-8377
Mailing Address - Fax:718-323-9377
Practice Address - Street 1:14202 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11436-1402
Practice Address - Country:US
Practice Address - Phone:718-323-8377
Practice Address - Fax:718-323-9377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X, 3336H0001X, 3336M0002X, 332BP3500X, 3336C0002X, 332BN1400X, 3336C0004X, 332B00000X, 333600000X, 3336C0003X, 3336M0003X
NY0302053336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336C0002XSuppliersPharmacyClinic Pharmacy
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3264582Medicaid
2125600OtherPK