Healthcare Provider Details

I. General information

NPI: 1477999555
Provider Name (Legal Business Name): EVANS DRUGS SUNRISE BEACH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13655 N STATE HIGHWAY 5
SUNRISE BEACH MO
65079-7449
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 573-372-8305
  • Fax: 573-372-8308
Mailing address:
  • Phone: 417-876-3313
  • Fax: 417-876-2326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2013013674
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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