Healthcare Provider Details

I. General information

NPI: 1114026820
Provider Name (Legal Business Name): ACH EVANS-CARSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7490 SOUTHERLAND CIRCLE ROBINSON CLINIC
FT CARSON CO
80913
US

IV. Provider business mailing address

EVANS ARMY COMMUNITY HOSPITAL 1650 COCHRANE CIRCLE BLDG 7500 ROOM 1036 ATTN TREASURERS OFFICE
FT CARSON CO
80913-4604
US

V. Phone/Fax

Practice location:
  • Phone: 719-524-4141
  • Fax: 719-524-2258
Mailing address:
  • Phone: 719-524-4141
  • Fax: 719-524-2258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332000000X
TaxonomyMilitary/U.S. Coast Guard Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HECTOR MORALES
Title or Position: CHIEF DHA PASS
Credential:
Phone: 210-536-6650