Healthcare Provider Details

I. General information

NPI: 1891701132
Provider Name (Legal Business Name): ANDREA L EVANICH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W MAIN ST
LOUISVILLE OH
44641-1338
US

IV. Provider business mailing address

13074 LOUISVILLE ST NE
PARIS OH
44669-9623
US

V. Phone/Fax

Practice location:
  • Phone: 330-875-5525
  • Fax: 330-875-9798
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-1-24756
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: