Provider Demographics
NPI:1962892521
Name:EVERGREEN HEALTH
Entity type:Organization
Organization Name:EVERGREEN HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WAN-CHIH
Authorized Official - Middle Name:
Authorized Official - Last Name:TOM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:425-899-2783
Mailing Address - Street 1:12040 NE 128TH ST
Mailing Address - Street 2:EVERGREENHEALTH MS-31
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3013
Mailing Address - Country:US
Mailing Address - Phone:425-899-2783
Mailing Address - Fax:425-899-2784
Practice Address - Street 1:12040 NE 128TH ST
Practice Address - Street 2:EVERGREENHEALTH MS-31
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3013
Practice Address - Country:US
Practice Address - Phone:425-899-2783
Practice Address - Fax:425-899-2784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center