Healthcare Provider Details

I. General information

NPI: 1821078247
Provider Name (Legal Business Name): MICHAEL ANTHONY EVANS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ACADEMY AVE SYSTEM THERAPEUTICS
DANVILLE PA
17822-9800
US

IV. Provider business mailing address

27 PINE RD
STILLWATER PA
17878-9361
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-5594
  • Fax:
Mailing address:
  • Phone: 570-864-2822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP042952L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: