EVERGREEN PHARMACEUTICAL, LLC (NPI# 1982746897) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982746897 |
| Entity Type | Organization |
| Organization Name | EVERGREEN PHARMACEUTICAL, LLC |
| Practice Address |
12220 113th Ave Ne Suite 1000 Kirkland WA 98034-6915 |
| Mailing Address |
201 E 4th St 900 Omnicare Center Cincinnati OH 45202-4248 |
| Practice Telephone | 4258207600 |
| Mailing Telephone | 5137192600 |
| Mailing Fax Number | 5137192635 |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2012-09-28 |
| Authorized Official Name | JONATHAN KUKULSKI (SECRETARY) |
| Authorized Official Telephone | 5137192600 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332BN1400X |
Durable Medical Equipment & Medical Supplies Specialization: Nursing Facility Supplies |
Suppliers | ||
| N | 332BP3500X |
Durable Medical Equipment & Medical Supplies Specialization: Parenteral & Enteral Nutrition |
Suppliers | ||
| N | 332BX2000X |
Durable Medical Equipment & Medical Supplies Specialization: Oxygen Equipment & Supplies |
Suppliers | ||
| Y | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 9049883 | 05 | |
| WA | 9046376 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255433447 | Evergreen Pharmaceutical, LLC | Pharmacy | 1751 Circle Ln Se, Lacey, WA 98503-2570 | 2006-09-01 |
| 1750492617 | Evergreen Pharmaceutical, LLC | Pharmacy | 350 E 3rd Ave, Spokane, WA 99202-1413 | 2006-08-31 |
| 1982715124 | Evergreen Pharmaceutical, LLC | Pharmacy | 12674 Gateway Dr S, Tukwila, WA 98168-3307 | 2006-08-31 |
| 1780795765 | Evergreen Pharmaceutical, LLC | Pharmacy | 259 E Barnett Rd Ste L, Medford, OR 97501-7953 | 2006-08-31 |
| 1235240391 | Evergreen Pharmaceutical, LLC | Pharmacy | 11933 Ne Glenn Widing Dr, Portland, OR 97220-9099 | 2006-08-31 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | EVERGREEN PHARMACEUTICAL, LLC | 900 Omnicare Center, 201 East Fourth Street, Cincinnati, OH 45202 |
| Washington State Corporations | EVERGREEN PHARMACEUTICAL, LLC | 1600 Rivercenter Blvd, Covington, KY 41011 |
| Street Address |
12220 113TH AVE NE SUITE 1000 |
| City | KIRKLAND |
| State | WA |
| Zip Code | 98034-6915 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497167357 | Rebecca Askland | Counselor | 12220 113th Ave Ne, Suite 210, Kirkland, WA 98034-6915 | 2014-05-27 |
| 1154871994 | Katie Chang | Dietitian, Registered | 12220 113th Ave Ne, Suite 210, Kirkland, WA 98034-6915 | 2016-10-05 |
| 1215395330 | Annie Tookey | Marriage & Family Therapist | 12220 113th Ave Ne, Ste 180, Kirkland, WA 98034-6915 | 2016-02-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578116596 | Rachel Bowers | Behavior Technician | 1335 Northeast 122nd Way, Suite 105, Kirkland, WA 98034 | 2019-07-18 |
| 1740841048 | Kristina Louise Inghram | Behavior Technician | 11415 Ne 128th St., Suite 40, Kirkland, WA 98034 | 2019-06-26 |
| 1053978064 | Matthew A. Bagnulo, Dds, Ps | Dentist | 11830 Ne 128th St., #202, Kirkland, WA 98034 | 2019-05-24 |
| 1629568928 | Stephanie Michalko | Optometrist | 11800 Ne 128th St Ste 110, Kirkland, WA 98034 | 2018-05-14 |
| 1952800013 | Heath Family Counseling LLC | Marriage & Family Therapist | 12025 115th Ave. Ne, Building D, Ste 200, Kirkland, WA 98034 | 2018-02-05 |
| 1891202834 | Barbara Josephine Gorham | Counselor | 2025 115th Ave Ne, Bldg D, #200, Kirkland, WA 98034 | 2017-12-29 |
| 1548782915 | Eleanor Hollis Wall | Counselor | 14340 102nd Ave Ne, Kirkland, WA 98034 | 2017-07-07 |
| 1457885212 | Peter Schoonmaker | Hospitalist | 12040 Ne 128th Street, Ms105, Kirkland, WA 98034 | 2017-04-18 |
| 1780124370 | Rebecca Managan | Advanced Practice Midwife | 12303 Ne 130th Ln Ste Coral225, Kirkland, WA 98034 | 2017-03-01 |
| 1669821104 | Winter Gonzalez | Counselor | 11720 97th Ln Ne Apt A411, Kirkland, WA 98034 | 2016-06-06 |
| Find all providers in zip 98034 | ||||
| Taxonomy Code | 3336L0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Long Term Care Pharmacy |
| A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316577869 | Ksr Health Care LLC | Pharmacy | 507 W Stevens Ave Ste Aaa, Sultan, WA 98294-9515 | 2020-01-23 |
| 1730724105 | Silver Lake Pharmacy Inc | Pharmacy | 10315 19th Ave Se Ste 104, Everett, WA 98208-4268 | 2019-11-09 |
| 1437708641 | Ets Consulting LLC | Pharmacy | 6007 244th St Sw Ste A1, Mountlake Terrace, WA 98043-5427 | 2019-09-10 |
| 1891341616 | Nwpa Inc | Pharmacy | 21509 State Route 410 E Ste 4, Bonney Lake, WA 98391-4104 | 2019-08-16 |
| 1669033288 | Suncrest Pharmacy Group, LLC | Pharmacy | 5919f Highway 291, Nine Mile Falls, WA 99026 | 2019-06-25 |
| 1750948956 | Lacey Square Pharmacy Inc | Pharmacy | 6020 Pacific Ave Se Ste C, Lacey, WA 98503-1319 | 2019-05-22 |
| 1306338868 | Manhattan Village Pharmacy Inc. | Pharmacy | 10102 E Knox Ave Ste 400, Spokane Valley, WA 99206-4146 | 2018-05-31 |
| 1528566981 | Rxltc, Pllc | Pharmacy | 969 Stevens Dr Ste 1b, Richland, WA 99352 | 2018-01-31 |
| 1891167755 | Think Different | Pharmacy | 31710 50th Ln Sw Apt V201, Federal Way, WA 98023-3747 | 2015-10-30 |
| 1104207372 | Prescription Pharmacy Pllc | Pharmacy | 800 Swift Blvd Ste 140, Richland, WA 99352-3559 | 2015-06-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.