Healthcare Provider Details

I. General information

NPI: 1497864359
Provider Name (Legal Business Name): EVANS ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64288 HIGHWAY 41
PEARL RIVER LA
70452-3602
US

IV. Provider business mailing address

64288 HIGHWAY 41
PEARL RIVER LA
70452-3602
US

V. Phone/Fax

Practice location:
  • Phone: 985-863-3100
  • Fax: 985-863-0790
Mailing address:
  • Phone: 985-863-3100
  • Fax: 985-863-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2937
License Number StateLA

VIII. Authorized Official

Name: MR. DAVID C EVANS
Title or Position: PRESIDENT
Credential: RPH PD
Phone: 985-863-3100