Organization
EVERGREEN PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD A PEARSON (CEO)
(414) 727-5750
Entity
Organization
Contact information
Practice address
10101 W GREENFIELD AVE, WEST ALLIS, WI 53214-3953
(414) 533-6600
(414) 533-6601
Mailing address
10101 W GREENFIELD AVE, WEST ALLIS, WI 53214-3953
(414) 533-6600
(414) 533-6601
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
9421-42
WI
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9421-42
STATE PHARMACY LICENSE
WI
Enumeration date
09/05/2016
Last updated
03/07/2023
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