MEDICARE: MR. EVAN JAMES VICKERS R.PH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	1436311701	UT

General Provider Information

NPI Number	:	1306845730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EVAN JAMES VICKERS R.PH

Provider Business Mailing Address
First Line	:	2166 N COBBLECREEK DR
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84721-9714
Country	:	US
Telephone Number	:	435-586-4399
Fax Number	:	435-586-3473

Provider Business Practice Location Address
First Line	:	91 N MAIN ST
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-2648
Country	:	US
Telephone Number	:	435-586-9651
Fax Number	:	435-586-3473

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	06/17/2009

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