Evergreen Pharmaceutical LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

EVERGREEN PHARMACEUTICAL LLC

Doing business as

Omnicare of Portland #48329

Practice address

11933 NE Glenn Widing Dr
Portland, OR 97220-9099

Phone

(503) 254-1647

Fax

(503) 262-8763

NPI assigned

Aug 31, 2006

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 Portland #48329 Doing business as

Medicare fee-for-service enrollment

Enrolled in OR2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 2

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

• Evergreen Pharmaceutical, LLC

  • Long Term Care Pharmacy
  • Spokane, WA
  • NPI 1750492617

  5193843928

  Same PAC ID
• Evergreen Pharmaceutical, LLC

  • Long Term Care Pharmacy
  • Tukwila, WA
  • NPI 1982715124

  5193843928

  Same PAC ID

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

Tax ID family

Evergreen Pharmaceutical LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Evergreen Pharmaceutical, LLC

  • Long Term Care Pharmacy
  • Spokane, WA
  • NPI 1750492617
  NPD tax ID
• Evergreen Pharmaceutical, LLC

  • Long Term Care Pharmacy
  • Tukwila, WA
  • NPI 1982715124
  NPD tax ID

Member of 2

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

• CVS Pharmacy Inc

  • Pharmacy
  • Dallas, TX
  • NPI 1578667366

  Member Of

  NPD member
• Neighborcare Pharmacy Services, LLC

  • Long Term Care Pharmacy
  • San Antonio, TX
  • NPI 1174559694

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721174400000",
    "number": "1235240391",
    "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": "11933 NE GLENN WIDING DR",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972209099",
            "telephone_number": "503-254-1647",
            "fax_number": "503-262-8763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PHARMACEUTICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "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 Portland #48329",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Evergreen Hospital Dentistry
• Evergreen Integrative Medicine, LLC
• Evergreen Medical Solutions LLC
• Evergreen Oregon Healthcare Portland, L.L.C.
• Evergreen Pelvic Health and Wellness LLC
• Evergreen Prosthetics and Orthotics, LLC
• Evergreen Prosthetics and Orthotics, LLC
• Evergreen Prosthetics and Orthotics, LLC
• Evergreen Prosthetics and Orthotics, LLC
• Evergreen Recovery Center

• Long Term Care Pharmacy in Portland, OR
• Providers in Portland, OR by specialty
• Long Term Care Pharmacy in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; 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.