EVERGREEN PHARMACY LLC (NPI# 1487101754) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487101754 |
| Entity Type | Organization |
| Organization Name | EVERGREEN PHARMACY LLC |
| Practice Address |
10101 W Greenfield Ave West Allis WI 53214-3953 |
| Practice Telephone | 4145336600 |
| Practice Fax Number | 4145336601 |
| Mailing Telephone | 4145336600 |
| Mailing Fax Number | 4145336601 |
| Enumeration Date | 2016-09-05 |
| Last Update Date | 2020-05-10 |
| Authorized Official Name | RICHARD A PEARSON (CEO) |
| Authorized Official Telephone | 4147275750 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
Suppliers | ||
| N | 3336S0011X |
Pharmacy Specialization: Specialty Pharmacy |
Suppliers | ||
| Y | 333600000X | Pharmacy | 9421-42 | WI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | STATE PHARMACY LICENSE | 9421-42 | 01 |
| DEA | FE6306028 | 01 |
| Street Address |
10101 W GREENFIELD AVE |
| City | WEST ALLIS |
| State | WI |
| Zip Code | 53214-3953 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740740208 | Melanie Figueroa | Counselor | West Milwaukee Ctc, 1610 Miller Park Way, West Milwaukee, WI 53214 | 2019-03-21 |
| 1619403011 | Lea Salome Denny | Counselor | 8626b W Greenfield Ave, Suite B300, West Allis, WI 53214 | 2017-05-04 |
| 1891148318 | West Allis Prescription Center Inc | Pharmacy | 6737 W Washington Ave, Suite 1100, West Allis, WI 53214 | 2016-07-20 |
| 1316390495 | Kristina Overlee | Nurse Practitioner | 6737 W. Washington Street, Suite 2150, West Allis, WI 53214 | 2016-07-13 |
| 1801239843 | Daniel Anthony Cichy | Pharmacist | 10101 W Greenfield Ave Ste 130, West Allis, WI 53214 | 2013-04-09 |
| 1295072544 | Wisconsin Vision, Inc. | Optometrist | 1220 Miller Park Way, West Milwaukee, WI 53214 | 2013-01-07 |
| 1831457720 | Kevin Konieczka | Physical Therapist | 1224 Miller Parkway, Milwaukee, WI 53214 | 2012-04-27 |
| 1497031843 | Jill Elizabeth Gerou | Registered Nurse | 8420 West Greenfield Ave, Apartment #7, West Allis, WI 53214 | 2011-10-31 |
| 1700176815 | Carolyn Hasek | Counselor | 1126 S 70th St Ste 112-113, West Allis, WI 53214 | 2011-04-10 |
| 1972802775 | Barbara Smith | Licensed Practical Nurse | 651 S 63 St, Apt1, Milwaukee, WI 53214 | 2011-03-18 |
| Find all providers in zip 53214 | ||||
| Taxonomy Code | 333600000X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891148318 | West Allis Prescription Center Inc | Pharmacy | 6737 W Washington Ave, Suite 1100, West Allis, WI 53214 | 2016-07-20 |
| 1467581595 | Aurora Pharmacy, Inc. | Pharmacy | 8615 W Beloit Rd, West Allis, WI 53227-3711 | 2007-03-05 |
| 1164509949 | Good Value Pharmacy LLC | Pharmacy | 10233 W Greenfield Ave, West Allis, WI 53214-3911 | 2006-11-01 |
| 1770514812 | K Mart Corp | Pharmacy | 6900 W Greenfield Ave, West Allis, WI 53214-4849 | 2006-07-06 |
| 1073580403 | Methodist Manor Health Center, Inc. | Pharmacy | 8615 W Beloit Rd, West Allis, WI 53227-3711 | 2006-03-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497355002 | Long Life Pharmacy 2 LLC | Pharmacy | 1225 W Historic Mitchell St Ste 217, Milwaukee, WI 53204-3382 | 2020-11-01 |
| 1710527783 | Sage Specialty Pharmacy Inc. | Pharmacy | 4001 N. Oakland Ave, Shorewood, WI 53211 | 2020-01-08 |
| 1790333623 | Froedtert Health Pharmacy LLC | Pharmacy | 9200 W Wisconsin Ave Ste 200w, Milwaukee, WI 53226-3522 | 2019-09-04 |
| 1225686405 | Froedtert Health Pharmacy LLC | Pharmacy | 9200 W Wisconsin Ave Ste 200c, Milwaukee, WI 53226-3522 | 2019-08-30 |
| 1134777337 | Froedtert Health Pharmacy LLC | Pharmacy | 11430 N Port Washington Rd Ste 103, Mequon, WI 53092-3414 | 2019-08-30 |
| 1619524766 | University Rx LLC | Pharmacy | 133 E College Ave, Appleton, WI 54911 | 2019-08-23 |
| 1053967026 | Accurabenefits, LLC | Pharmacy | 2413 Woodland Ter, Neenah, WI 54956-4824 | 2019-08-14 |
| 1184276917 | St. Clare Health Mission Pharmacy | Pharmacy | 916 Ferry St, La Crosse, WI 54601-4717 | 2019-07-11 |
| 1851851141 | Dean Retail Services, Inc. | Pharmacy | 740 Reena Ave Ste 300, Fort Atkinson, WI 53538-3145 | 2019-03-22 |
| 1093287237 | Del Mar Pharmacy Sc | Pharmacy | 1000 S Cesar E Chavez Dr, Milwaukee, WI 53204-2203 | 2018-12-28 |
| Find all providers with the same taxonomy | ||||
| City | WEST ALLIS |
| Zip Code | 53214 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.