{"npi":"1487101754","type":"NPI-2","status":"active","name":{"display":"Evergreen Pharmacy LLC","other":[],"organization_name":"EVERGREEN PHARMACY LLC","authorised_official":"Richard Pearson"},"specialty":{"primary_taxonomy":"333600000X","primary_taxonomy_description":"Pharmacy","slug":"pharmacy","schema_org_specialty":null,"all":[{"code":"3336L0003X","description":"Long Term Care Pharmacy","primary":false,"state":null,"license":null},{"code":"3336S0011X","description":"Specialty Pharmacy","primary":false,"state":null,"license":null},{"code":"333600000X","description":"Pharmacy","primary":true,"state":"WI","license":"9421-42"}]},"addresses":[{"purpose":"LOCATION","street_1":"10101 W GREENFIELD AVE","city":"WEST ALLIS","state":"WI","postal_code":"532143953","country_code":"US","phone":"4145336600","fax":"4145336601"},{"purpose":"MAILING","street_1":"10101 W GREENFIELD AVE","city":"WEST ALLIS","state":"WI","postal_code":"532143953","country_code":"US","phone":"4145336600","fax":"4145336601"}],"license":{"state":"WI","number":"9421-42"},"identifiers":[{"type_code":"01","label":"Other","value":"9421-42","state":"WI","issuer":"STATE PHARMACY LICENSE"}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20210325002143","type_code":"12-73","type_desc":"PART B SUPPLIER - MASS IMMUNIZATION (ROSTER BILLER ONLY)","state":"WI","pac_id":"1456694306"}]},"enumeration_date":"2016-09-05","last_updated":"2023-03-07","_meta":{"source":"NPPES","snapshot_date":"2023-03-07","doc_url":"https://findmynpi.com/api"}}