Healthcare Provider Details

I. General information

NPI: 1396254389
Provider Name (Legal Business Name): CHANDRA MISON EVANS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2553 E SILVER SPRINGS BLVD
OCALA FL
34470-7009
US

IV. Provider business mailing address

9690 SW 53RD TER
OCALA FL
34476-8646
US

V. Phone/Fax

Practice location:
  • Phone: 352-877-7177
  • Fax:
Mailing address:
  • Phone: 901-282-9055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberPS54436
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23862
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: