NPIMap

Organization Active NPI

Evergreen Pharmaceutical, LLC

  • Long Term Care Pharmacy
  • Tukwila, WA
National Provider Identifier
1982715124
Registry record updated Mar 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
EVERGREEN PHARMACEUTICAL, LLC
Doing business as
Omnicare of Seattle
Omnicare of Seattle #48376
Practice address
12674 Gateway Dr S
Tukwila, WA 98168-3307
Phone
(425) 820-7600
Fax
(425) 825-2226
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2019

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

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

12674 Gateway Dr S
Tukwila, WA 98168-3307

Mailing address

1 CVS Dr
Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500

Other names 2

  • Omnicare of Seattle Doing business as
  • Omnicare of Seattle #48376 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930029538 WA DME Supplier - Pharmacy 5193843928 Practice locations: Tukwila, WA
O20150729009936 WA Part B Supplier - Mass Immunization (Roster Biller Only) 5193843928 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lacey, WA; Spokane, WA; Tukwila, WA

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

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

SupplierSuppliesMedicare assignment
Omnicare of Seattle #4837612674 Gateway Dr S, Tukwila, WA 98168-3307(425) 820-7600 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Parenteral Nutrients|Parenteral Equipment and/or Supplies Accepts assignmentParticipating since Jan 1, 1999

National Provider Directory

National Provider Directory
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.

Member of 2

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

Locations

12674 Gateway Dr S
Tukwila, WA 98168
Phone (425) 820-7600

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551398400000",
    "number": "1982715124",
    "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": "12674 GATEWAY DR S",
            "city": "TUKWILA",
            "state": "WA",
            "postal_code": "981683307",
            "telephone_number": "425-820-7600",
            "fax_number": "425-825-2226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PHARMACEUTICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2019-03-01",
        "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 Seattle",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Omnicare of Seattle #48376",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tukwila, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2019; 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.