Evergreen Pharmacy Llc
LBN: Evergreen Pharmacy Llc
Evergreen Pharmacy Llc is an health care organization with primary practice located at 10101 W Greenfield Ave , West Allis WI 53214-3953. The organization recently has 3 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Long Term Care Pharmacy, Suppliers / Specialty Pharmacy. Suppliers / Pharmacy is the primary health care specialty.
Evergreen Pharmacy Llc can be contacted via phone (414) 533-6600, or through Pearson, Richard A via phone (414) 727-5750.
Contact Information
Primary practice address
10101 W Greenfield Ave
West Allis WI 53214-3953
Phone: (414) 533-6600
Fax: (414) 533-6601
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Pharmacy | 333600000X | 9421-42 | Wisconsin |
| Suppliers / Long Term Care Pharmacy | 3336L0003X | ||
| Suppliers / Specialty Pharmacy | 3336S0011X |
Profile Details
| NPI number | 1487101754 |
|---|---|
| LBN Legal business name | Evergreen Pharmacy Llc |
| DBA Doing business as | |
| Authorized official | Pearson, Richard A |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Sep 5th, 2016 |
| Last updated | Mar 7th, 2023 - about last year |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1487101754 | NPPES |
| Wisconsin | Other | 9421-42 | STATE PHARMACY LICENSE |
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