Healthcare Provider Details

I. General information

NPI: 1578206645
Provider Name (Legal Business Name): EP EVANS DRUG, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S OAK ST
NEVADA MO
64772-3436
US

IV. Provider business mailing address

200 E US HIGHWAY 54
EL DORADO SPG MO
64744-1926
US

V. Phone/Fax

Practice location:
  • Phone: 417-876-5601
  • Fax: 417-876-5604
Mailing address:
  • Phone: 417-876-5601
  • Fax: 417-876-5604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: RENEA HAYES
Title or Position: MANAGER
Credential:
Phone: 417-876-5601