Healthcare Provider Details

I. General information

NPI: 1518041532
Provider Name (Legal Business Name): JOHN M EVANS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 NE 11TH AVE
CANBY OR
97013-3027
US

IV. Provider business mailing address

179 NE 11TH AVE
CANBY OR
97013-3027
US

V. Phone/Fax

Practice location:
  • Phone: 503-899-9253
  • Fax: 503-216-0630
Mailing address:
  • Phone: 503-899-9253
  • Fax: 503-216-0630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8266
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: