Evergreen Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY51198 Issued in CA

Legal business name

EVERGREEN PHARMACY INC

Practice address

2365 Quimby Rd Ste 150
San Jose, CA 95122-1337

Phone

(408) 531-9961

Fax

(855) 831-7973

NPI assigned

Mar 2, 2016

Organization subpart

No

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

Authorized official

Name

Kevin Dang, RPHNPI 1063861466

Title

President,Pic, Ao

Phone

(408) 391-0700

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

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

• Evergreen Pharmacy Inc

  • Community/Retail Pharmacy
  • San Jose, CA
  • NPI 1396933545

  0143426536

  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 Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Evergreen Pharmacy Inc

  • Community/Retail Pharmacy
  • San Jose, CA
  • NPI 1396933545
  NPD tax ID

Locations

Practitioners 1

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

• Kevin Dang, PHARM.D

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • San Jose, CA
  • NPI 1063861466
  NPD Authorized official

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

{
    "created_epoch": "1456876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528243200000",
    "number": "1861852030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "EVERGREEN PHARMACY",
            "address_2": "PO BOX 731582",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951731582",
            "telephone_number": "408-531-9961",
            "fax_number": "855-831-7973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2365 QUIMBY RD STE 150",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951221337",
            "telephone_number": "408-531-9961",
            "fax_number": "855-831-7973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-02",
        "last_updated": "2018-06-06",
        "status": "A",
        "authorized_official_last_name": "DANG",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT,PIC, AO",
        "authorized_official_telephone_number": "408-391-0700",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY51198",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2158376",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Evergreen Medical Group, Inc.
• Evergreen Natural Healing Arts
• Evergreen Pediatric Associates Inc.
• Evergreen Pediatrics Inc
• Evergreen Pharmacy Inc
• Evergreen Physical Therapy
• Evergreen Sleep Center
• Evergreen Surgery Center, LLC
• Evergreen Urgent Care Inc
• Evergreen Valley Home Health LLC

• Community/Retail Pharmacy in San Jose, CA
• Providers in San Jose, 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 Jun 6, 2018; 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.