Evergreen Pharmacy LLC

Primary specialty

PharmacyTaxonomy code 333600000X

License

9421-42 Issued in WI

Legal business name

EVERGREEN PHARMACY LLC

Practice address

10101 W Greenfield Ave
West Allis, WI 53214-3953

Phone

(414) 533-6600

Fax

(414) 533-6601

NPI assigned

Sep 5, 2016

Organization subpart

No

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

Authorized official

Name

Richard A Pearson

Title

Ceo

Phone

(414) 727-5750

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joshua Becco

  • Pharmacist
  • West Allis, WI
  • NPI 1144817081
  NPD
• Daniel Anthony Cichy, PHARM D

  • Pharmacist
  • West Milwaukee, WI
  • NPI 1801239843
  NPD (past)
• Andrew R Hochradel, PHARM.D.

  • Pharmacist
  • Glendale, WI
  • NPI 1962755454
  NPD (past)
• Brendan Douglas Lehman, PHARMD

  • Pharmacist
  • West Allis, WI
  • NPI 1982377669
  NPD (past)
• Kimberly M Mellenthin, PHARMD

  • Pharmacist
  • West Allis, WI
  • NPI 1013485515
  NPD (past)
• Taylor Lee Page, PHARMD

  • Pharmacist
  • West Allis, WI
  • NPI 1659925006
  NPD (past)
• Alexandria Ramczyk, PHARMD

  • Pharmacist
  • Menomonee Falls, WI
  • NPI 1326510637
  NPD (past)

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

{
    "created_epoch": "1473033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1487101754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10101 W GREENFIELD AVE",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532143953",
            "telephone_number": "414-533-6600",
            "fax_number": "414-533-6601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10101 W GREENFIELD AVE",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532143953",
            "telephone_number": "414-533-6600",
            "fax_number": "414-533-6601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-05",
        "last_updated": "2023-03-07",
        "certification_date": "2020-05-10",
        "status": "A",
        "authorized_official_last_name": "PEARSON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "414-727-5750"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "WI",
            "license": "9421-42",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE PHARMACY LICENSE",
            "identifier": "9421-42",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacy in West Allis, WI
• Providers in West Allis, WI by specialty
• Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.