Healthcare Provider Details

I. General information

NPI: 1558877563
Provider Name (Legal Business Name): CARA EVANS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 42ND AVE N
NEW HOPE MN
55427-1100
US

IV. Provider business mailing address

8200 42ND AVE N
NEW HOPE MN
55427-1100
US

V. Phone/Fax

Practice location:
  • Phone: 763-531-7462
  • Fax: 763-535-5987
Mailing address:
  • Phone: 763-531-7462
  • Fax: 763-535-5987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21430
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number122386
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: