Healthcare Provider Details

I. General information

NPI: 1487635827
Provider Name (Legal Business Name): JENNIFER L EVANS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 LLEWELLYN AVE KIMBROUGH AMBULATORY CARE CENTER
FORT MEADE MD
20755-5800
US

IV. Provider business mailing address

2016 CARTER MILL WAY
BROOKEVILLE MD
20833-2243
US

V. Phone/Fax

Practice location:
  • Phone: 307-677-8395
  • Fax:
Mailing address:
  • Phone: 240-498-3971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number15642
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15642
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: