Healthcare Provider Details

I. General information

NPI: 1710078183
Provider Name (Legal Business Name): PATRICIA L EVANS R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 COLONY RD RT 210 EAST
MADISON HEIGHTS VA
24572
US

IV. Provider business mailing address

188 WINDY KNOB LN
APPOMATTOX VA
24522
US

V. Phone/Fax

Practice location:
  • Phone: 434-947-6156
  • Fax: 434-947-2988
Mailing address:
  • Phone: 434-352-5967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202005106
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: