# EVERGREEN PHARMACEUTICAL OF CALIFORNIA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Omnicare of Northern California, Omnicare of Northern California \#48214
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356429369
- **Authorized official:** SUSAN COLBERT (SR DIRECTOR, PAYER RELATIONS)
- **Authorized official phone:** (401) 770-2751

## Contact information

- **Practice address:** 850 S GUILD AVE, LODI, CA 95240-3170
- **Practice address phone:** (209) 333-4900
- **Practice address fax:** (209) 333-3601
- **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:** 11/01/2006
- **Last updated:** 01/04/2021