Evergreen Pharmaceutical of California, LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

EVERGREEN PHARMACEUTICAL OF CALIFORNIA, LLC

Doing business as

Omnicare of Santa Rosa #48218

Practice address

879 2ND St
Santa Rosa, CA 95404-4621

Phone

(707) 578-0399

NPI assigned

Aug 29, 2006

Last updated

Jan 4, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Susan Colbert

Title

Sr Director, Payer Relations

Phone

(401) 770-2751

Specialties & licenses 1

Addresses

Other names 1

• Omnicare of Santa Rosa #48218 Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Evergreen Pharmaceutical of California, LLC

  dba Omnicare of Northern California

  • Long Term Care Pharmacy
  • Lodi, CA
  • NPI 1356429369

  3274573829

  Same PAC ID
• Evergreen Pharmaceutical of California, LLC

  dba Omnicare of Cerritos

  • Long Term Care Pharmacy
  • Cerritos, CA
  • NPI 1679685994

  3274573829

  Same PAC ID
• Evergreen Pharmaceutical of California, LLC

  dba Omnicare of Southern California #48210

  • Long Term Care Pharmacy
  • Canoga Park, CA
  • NPI 1821010729

  3274573829

  Same PAC ID
• Evergreen Pharmaceutical of California, LLC

  dba Omnicare of Hayward #48213

  • Long Term Care Pharmacy
  • Hayward, CA
  • NPI 1871605105

  3274573829

  Same PAC ID

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Evergreen Pharmaceutical of California, LLC

  dba Omnicare of Northern California

  • Long Term Care Pharmacy
  • Lodi, CA
  • NPI 1356429369

  O20090413000320

  Same enrollment
• Evergreen Pharmaceutical of California, LLC

  dba Omnicare of Cerritos

  • Long Term Care Pharmacy
  • Cerritos, CA
  • NPI 1679685994

  O20090413000320

  Same enrollment
• Evergreen Pharmaceutical of California, LLC

  dba Omnicare of Southern California #48210

  • Long Term Care Pharmacy
  • Canoga Park, CA
  • NPI 1821010729

  O20090413000320

  Same enrollment
• Evergreen Pharmaceutical of California, LLC

  dba Omnicare of Hayward #48213

  • Long Term Care Pharmacy
  • Hayward, CA
  • NPI 1871605105

  O20090413000320

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• CVS Pharmacy Inc.

  dba CVS Pharmacy #17247

  • Pharmacy
  • North Dartmouth, MA
  • NPI 1831271071

  Member Of

  NPD member

Locations

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Arnold Bangchan

  • Pharmacist
  • Canoga Park, CA
  • NPI 1568900819
  NPD (past)
• Jameel Ebrahim Chaugule, R. PH.

  • Pharmacist
  • Los Alamitos, CA
  • NPI 1770606451
  NPD (past)
• Romany Ibrahim, PHARMACIST

  • Pharmacist
  • Santa Maria, CA
  • NPI 1881158665
  NPD (past)
• Phuong-Anh La, PHARMACIST

  • Pharmacist
  • San Diego, CA
  • NPI 1366254476
  NPD (past)
• Amber Lopez, PHARMD

  • Pharmacist
  • Lodi, CA
  • NPI 1659970937
  NPD (past)
• Gary Lowe, PHARM D

  • Pharmacist
  • Canoga Park, CA
  • NPI 1093498156
  NPD (past)
• Abdulla Nooristani

  • Psychiatric Pharmacist
  • Sacramento, CA
  • NPI 1205457918
  NPD (past)
• Lynn Nguyen Wong, PHARM.D

  • Pharmacist
  • Sacramento, CA
  • NPI 1386886315
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609718400000",
    "number": "1013026608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CVS DR",
            "address_2": "BOX 1075",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028956146",
            "telephone_number": "401-765-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "879 2ND ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954044621",
            "telephone_number": "707-578-0399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PHARMACEUTICAL OF CALIFORNIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2021-01-04",
        "certification_date": "2021-01-04",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "SR DIRECTOR, PAYER RELATIONS",
        "authorized_official_telephone_number": "401-770-2751"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Omnicare of Santa Rosa #48218",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nancy Goebel Evans, RNP
• Nicole Evans
• Oliver Skye Evans
• Stacey Evans
• Timothy P Everette, MFT INTERN
• Jesse Evers
• Eileen Evind, ASW
• Evolve Restorative Center
• Joanne Ewart, M.S.
• Diana Ewing, LVN

• Long Term Care Pharmacy in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Long Term Care Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.