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General NPI Number Information
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NPI Number | 1821083783
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Entity Type | Individual
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Provider Name | DANA RENEE EVANS PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/16/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 902 E LINCOLN RD
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City | IDABEL
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State | OK
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Zip | 74745-7337
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Country | US
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Telephone | 580-286-2600
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Fax | 580-208-3032
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Provider Business Mailing Address
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Address Line | RR 5 BOX 595
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City | BROKEN BOW
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State | OK
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Zip | 74728-8947
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Country | US
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Telephone | 580-420-3551
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Fax | 580-208-3032
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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 | 12581
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License Number State | OK
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