Healthcare Provider Details

I. General information

NPI: 1144100132
Provider Name (Legal Business Name): SHAVEZ JORDAN EVANS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2384 BRANDERMILL BLVD
GAMBRILLS MD
21054-1850
US

IV. Provider business mailing address

900 HALL STATION DR APT 100
BOWIE MD
20721-6015
US

V. Phone/Fax

Practice location:
  • Phone: 443-302-6279
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30502
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: