Evergreen RX Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY51906 Issued in CA

Legal business name

EVERGREEN RX INC

Doing business as

Medico Pharmacy

Practice address

11779 Santa Monica Blvd
Los Angeles, CA 90025-2843

Phone

(310) 444-9011

Fax

(310) 444-0418

NPI assigned

Aug 9, 2005

Last updated

Dec 3, 2024By 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

Yury Akopyan

Title

Owner

Phone

(310) 444-9011

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Medico Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Tax ID family

Aleracare Pharmacy California3 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.

• Unicare Pharmacy Inc

  • Specialty Pharmacy
  • Van Nuys, CA
  • NPI 1093555971
  NPD tax ID
• Unicare Pharmacy Inc

  dba AleraCare Pharmacy California

  • Home Infusion Agency
  • Van Nuys, CA
  • NPI 1255644357
  NPD tax ID

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733184000000",
    "number": "1346241700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11779 SANTA MONICA BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900252843",
            "telephone_number": "310-444-9011",
            "fax_number": "310-444-0418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11779 SANTA MONICA BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900252843",
            "telephone_number": "310-444-9011",
            "fax_number": "310-444-0418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN RX INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-09",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A",
        "authorized_official_last_name": "AKOPYAN",
        "authorized_official_first_name": "YURY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-444-9011"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY51906",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1346241700",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2151974",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medico Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marcia Lynn Everett, R.D.
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• Evergreen Wellness Center Inc.
• Matthew William Everhart, LCSW, MSW
• Everheal Medical Apc
• Brikeya Everitt
• Everlasting Adult Day Care Inc (Everlasting Adult Day Health Care Center)

• Community/Retail Pharmacy in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.