# EVERGREEN PHARMACEUTICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Omnicare of Portland \#48329
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235240391
- **Authorized official:** SUSAN COLBERT (SR DIRECTOR, PAYER RELATIONS)
- **Authorized official phone:** (401) 770-2751

## Contact information

- **Practice address:** 11933 NE GLENN WIDING DR, PORTLAND, OR 97220-9099
- **Practice address phone:** (503) 254-1647
- **Practice address fax:** (503) 262-8763
- **Mailing address:** 1 CVS DR, BOX 1075, WOONSOCKET, RI 02895-6146
- **Mailing address phone:** (401) 765-1500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 07/17/2024