Evergreen Pharmacy Inc

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

EVERGREEN PHARMACY INC

Practice address

4110 S Maryland Pkwy Ste 17
Las Vegas, NV 89119-7505

Phone

(702) 462-6262

Fax

(702) 462-5654

NPI assigned

Jan 31, 2020

Organization subpart

No

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

Authorized official

Name

Shereen Hassan

Title

Director

Phone

(480) 519-4640

Specialties & licenses 1

Addresses

Other names 1

• EVERGREEN PHARMACY Doing business as

Locations

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

{
    "created_epoch": "1580428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580428800000",
    "number": "1033740691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4110 S MARYLAND PKWY STE 17",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891197505",
            "telephone_number": "702-462-6262",
            "fax_number": "702-462-5654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4110 S MARYLAND PKWY STE 17",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891197505",
            "telephone_number": "702-462-6262",
            "fax_number": "702-462-5654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-31",
        "last_updated": "2020-01-31",
        "certification_date": "2020-01-31",
        "status": "A",
        "authorized_official_last_name": "HASSAN",
        "authorized_official_first_name": "SHEREEN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "480-519-4640"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EVERGREEN PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tony Ray Everett
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• Melissa Ann Everhart
• Stephanie Everhart
• Gina Christina Everitt
• Everlast Wellness Group LLC

• All providers in Las Vegas, NV
• Pharmacy in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.