Healthcare Provider Details

I. General information

NPI: 1447345525
Provider Name (Legal Business Name): EVANS DRUGS NEVADA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 W AUSTIN BLVD
NEVADA MO
64772-2805
US

IV. Provider business mailing address

209 E US HIGHWAY 54
EL DORADO SPRINGS MO
64744-1925
US

V. Phone/Fax

Practice location:
  • Phone: 417-667-3953
  • Fax: 417-448-5991
Mailing address:
  • Phone: 417-876-3313
  • Fax: 417-876-2326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number240468217
License Number StateMO

VIII. Authorized Official

Name: TRACY TIMMERMANN
Title or Position: MANAGER
Credential:
Phone: 417-876-3313