Healthcare Provider Details

I. General information

NPI: 1649051707
Provider Name (Legal Business Name): LAUREN LEIGH EVANKO I PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2023
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 INDIAN RIVER RD
ORANGE CT
06477-3649
US

IV. Provider business mailing address

254 ARGYLE RD
ORANGE CT
06477-2914
US

V. Phone/Fax

Practice location:
  • Phone: 475-209-9284
  • Fax:
Mailing address:
  • Phone: 860-790-4331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0016211
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: