MEDICARE: MR. ANTHONY LAMAR 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	5421	SC
2	183500000X	Pharmacist	TN11978	TN

General Provider Information

NPI Number	:	1407136401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY LAMAR EVANS PHARM-D

Provider Business Mailing Address
First Line	:	3901 DAYTON BLVD
Second Line	:
City	:	RED BANK
State	:	TN
Zip	:	37415-2715
Country	:	US
Telephone Number	:	423-877-9516
Fax Number	:	423-877-9458

Provider Business Practice Location Address
First Line	:	3901 DAYTON BLVD
Second Line	:
City	:	RED BANK
State	:	TN
Zip	:	37415-2715
Country	:	US
Telephone Number	:	423-877-9516
Fax Number	:	423-877-9458

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

Provider Enumeration Date	:	08/22/2011
Last Update Date	:	08/22/2011

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