MEDICARE: MR. DORON EVANS RPH

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	35076	NY

General Provider Information

NPI Number	:	1649502790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DORON EVANS RPH

Provider Business Mailing Address
First Line	:	952 MCDONALD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-5612
Country	:	US
Telephone Number	:	718-435-3100
Fax Number	:	718-435-1671

Provider Business Practice Location Address
First Line	:	952 MCDONALD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-5612
Country	:	US
Telephone Number	:	718-435-3100
Fax Number	:	718-435-1671

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

Provider Enumeration Date	:	01/31/2010
Last Update Date	:	01/31/2010

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