Healthcare Provider Details

I. General information

NPI: 1568925790
Provider Name (Legal Business Name): TINA L EVANS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2019
Last Update Date: 02/13/2021
Certification Date: 02/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 EAGLE DR
LOVELAND CO
80537-8058
US

IV. Provider business mailing address

1114 TURNSTONE LN
FORT COLLINS CO
80524-1758
US

V. Phone/Fax

Practice location:
  • Phone: 970-663-2048
  • Fax:
Mailing address:
  • Phone: 970-222-6799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12481
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: