Healthcare Provider Details

I. General information

NPI: 1598699852
Provider Name (Legal Business Name): MR. EUGENE RALPH EAVY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 N 4TH AVE
ANN ARBOR MI
48104-1003
US

IV. Provider business mailing address

709 N 4TH AVE
ANN ARBOR MI
48104-1003
US

V. Phone/Fax

Practice location:
  • Phone: 734-478-9679
  • Fax:
Mailing address:
  • Phone: 734-478-9679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302024343
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: