MEDICARE: EVANS PHARMACY LLC

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	333600000X	Pharmacy
2	3336L0003X	Long Term Care Pharmacy
3	3336C0003X	Community/Retail Pharmacy	5-7137	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2116853	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598913147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVANS PHARMACY LLC

Provider Business Mailing Address
First Line	:	110 N OAKWOOD RD
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73703-4946
Country	:	US
Telephone Number	:	580-234-4343
Fax Number	:	580-233-1208

Provider Business Practice Location Address
First Line	:	110 N OAKWOOD RD
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73703-4946
Country	:	US
Telephone Number	:	580-233-1202
Fax Number	:	580-233-1208

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KRISTI LYNN NUNLEY
Credential	:
Telephone Number	:	580-234-4343

Provider Enumeration Date	:	09/08/2008
Last Update Date	:	08/22/2019

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Directions to “EVANS PHARMACY LLC ” Practice Location

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