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General NPI Number Information
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NPI Number | 1750473633
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Entity Type | Individual
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Provider Name | THOMAS D EVANS JR. R.PH.
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Gender | Male
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2223 FLORIDA AVE
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City | LYNCHBURG
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State | VA
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Zip | 24501-4511
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Country | US
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Telephone | 434-846-8481
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Fax |
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Provider Business Mailing Address
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Address Line | 188 WINDY KNOB LN
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City | APPOMATTOX
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State | VA
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Zip | 24522-8398
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Country | US
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Telephone | 434-352-5967
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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 | 0202004231
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License Number State | VA
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