MEDICARE: BRANDON PAUL EVANS PHARM. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202210010	VA
2	183500000X	Pharmacist	PD11500	AR

General Provider Information

NPI Number	:	1275839409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON PAUL EVANS PHARM. D.

Provider Business Mailing Address
First Line	:	3631 PETERS CREEK RD NW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24019-2809
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 HICKS RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-6337
Country	:	US
Telephone Number	:	804-675-4519
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2011
Last Update Date	:	02/06/2011

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