Healthcare Provider Details

I. General information

NPI: 1063967362
Provider Name (Legal Business Name): JILLIAN EVANS PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LEXINGTON AVE
MANSFIELD OH
44907-2632
US

IV. Provider business mailing address

1857 SNYDER RD
BUTLER OH
44822-9690
US

V. Phone/Fax

Practice location:
  • Phone: 419-756-7023
  • Fax:
Mailing address:
  • Phone: 419-512-1662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03233197
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25724
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: