Healthcare Provider Details

I. General information

NPI: 1356434930
Provider Name (Legal Business Name): EVANS DRUG COMPANY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 LAKE STREET
FULTON KY
42041
US

IV. Provider business mailing address

214 LAKE STREET
FULTON KY
42041
US

V. Phone/Fax

Practice location:
  • Phone: 270-472-2421
  • Fax: 270-472-0103
Mailing address:
  • Phone: 270-472-2421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10684
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID S PRATER JR.
Title or Position: OWNER/PHARMACIST
Credential: PHARM D.
Phone: 270-472-2421