MEDICARE: REBECCA POOL EVATT PHARMD

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	RPH029911	GA

General Provider Information

NPI Number	:	1700308251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA POOL EVATT PHARMD

Provider Business Mailing Address
First Line	:	128 LYNNVIEW CT
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30252-5756
Country	:	US
Telephone Number	:	478-955-8243
Fax Number	:

Provider Business Practice Location Address
First Line	:	1114 GA HIGHWAY 96
Second Line	:
City	:	KATHLEEN
State	:	GA
Zip	:	31047-2111
Country	:	US
Telephone Number	:	478-987-6788
Fax Number	:

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

Provider Enumeration Date	:	07/15/2017
Last Update Date	:	07/15/2017

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