MEDICARE: DR. KEVIN PAUL EVANCIC 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	16500	NC

General Provider Information

NPI Number	:	1417958539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN PAUL EVANCIC PHARM D

Provider Business Mailing Address
First Line	:	799 CASTLE SHANNON BLVD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15234-1601
Country	:	US
Telephone Number	:	124-561-2417
Fax Number	:	412-561-7418

Provider Business Practice Location Address
First Line	:	799 CASTLE SHANNON BLVD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15234-1601
Country	:	US
Telephone Number	:	124-561-2417
Fax Number	:	412-561-7418

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	01/12/2021

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