Healthcare Provider Details

I. General information

NPI: 1386644839
Provider Name (Legal Business Name): EVANS DRUGS OF SAINT LOUIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 N MILL ST
SAINT LOUIS MI
48880-1521
US

IV. Provider business mailing address

116 N MILL ST
SAINT LOUIS MI
48880-1521
US

V. Phone/Fax

Practice location:
  • Phone: 989-681-6633
  • Fax: 989-681-6644
Mailing address:
  • Phone: 989-681-6633
  • Fax: 989-681-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5301006843
License Number StateMI

VIII. Authorized Official

Name: CHARLES WAYNE BROOKS
Title or Position: OWNER
Credential: RPH
Phone: 989-463-3356