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General NPI Number Information
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NPI Number | 1366910499
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Entity Type | Individual
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Provider Name | NATHAN EVERSON PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/07/2018
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Last Update Date | 11/07/2018
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Provider Practice Location Address
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Address Line | 1906 BELLEVIEW AVE SE
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City | ROANOKE
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State | VA
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Zip | 24014-1838
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Country | US
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Telephone | 540-206-6815
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Fax |
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Provider Business Mailing Address
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Address Line | 532 WOODS AVE SW
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City | ROANOKE
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State | VA
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Zip | 24016-4826
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Country | US
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Telephone | 906-298-0537
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 0202211933
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License Number State | VA
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