Evergreen Pharmacy LLC
NPI 1487101754ActiveOrganization· Pharmacy· West Allis, WI
Pharmacy in West Allis, Wisconsin, registered in NPPES in September 2016. The authorized official on file is Richard A. Pearson, Ceo. Enrolled in Medicare as part b supplier - mass immunization (roster biller only).
Overview
| NPI | 1487101754 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Sep 5, 2016 |
| Last updated in NPPES | Mar 7, 2023 |
| Certified by provider | May 10, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Pharmacy Primary | 333600000X | 9421-42 | WI |
| Pharmacy, Long Term Care Pharmacy | 3336L0003X | — | — |
| Pharmacy, Specialty Pharmacy | 3336S0011X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 4, 2026 | No match | — |
| New York OMIG · Nov 4, 2026 | No match | — |
| Ohio Medicaid · Nov 4, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 4, 2026 | No match | — |
| Washington HCA · Nov 4, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Mass Immunization (Roster Biller Only) (WI) |
|---|
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