Provider Demographics
NPI:1487928164
Name:EVERS LTC INC
Entity type:Organization
Organization Name:EVERS LTC 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:
Authorized Official - Phone:718-762-7400
Mailing Address - Street 1:3050 WHITESTONE EXPY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-1964
Mailing Address - Country:US
Mailing Address - Phone:718-762-7400
Mailing Address - Fax:718-762-7404
Practice Address - Street 1:3050 WHITESTONE EXPY STE 107
Practice Address - Street 2:SUITE 107
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-1995
Practice Address - Country:US
Practice Address - Phone:718-762-7400
Practice Address - Fax:718-762-7404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336H0001X, 3336S0011X, 332B00000X
NY0311393336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03444002Medicaid
5804605OtherNCPDP PROVIDER IDENTIFICATION NUMBER
5804605OtherNCPDP PROVIDER IDENTIFICATION NUMBER