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General NPI Number Information
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NPI Number | 1174030365
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Entity Type | Individual
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Provider Name | EVAN JOSEPH DEJOIE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 01/09/2018
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Last Update Date | 01/09/2018
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Provider Practice Location Address
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Address Line | 4031 POPPS FERRY RD STE A
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City | DIBERVILLE
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State | MS
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Zip | 39540-2367
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Country | US
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Telephone | 228-392-7310
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Fax |
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Provider Business Mailing Address
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Address Line | 16016 LEMOYNE BLVD APT 104
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City | BILOXI
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State | MS
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Zip | 39532-5168
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Country | US
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Telephone | 504-541-7225
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | E-14632
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License Number State | MS
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