Healthcare Provider Details

I. General information

NPI: 1821083783
Provider Name (Legal Business Name): DANA RENEE EVANS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 E LINCOLN RD
IDABEL OK
74745-7337
US

IV. Provider business mailing address

RR 5 BOX 595
BROKEN BOW OK
74728-8947
US

V. Phone/Fax

Practice location:
  • Phone: 580-286-2600
  • Fax: 580-208-3032
Mailing address:
  • Phone: 580-420-3551
  • Fax: 580-208-3032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12581
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: