MEDICARE: EVANS DRUGS NEVADA LLC

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	3336C0003X	Community/Retail Pharmacy	240468217	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447345525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVANS DRUGS NEVADA LLC

Provider Business Mailing Address
First Line	:	209 E US HIGHWAY 54
Second Line	:
City	:	EL DORADO SPRINGS
State	:	MO
Zip	:	64744-1925
Country	:	US
Telephone Number	:	417-876-3313
Fax Number	:	417-876-2326

Provider Business Practice Location Address
First Line	:	1407 W AUSTIN BLVD
Second Line	:
City	:	NEVADA
State	:	MO
Zip	:	64772-2805
Country	:	US
Telephone Number	:	417-667-3953
Fax Number	:	417-448-5991

Authorized Official
Title or Position	:	MANAGER
Name	:	TRACY TIMMERMANN
Credential	:
Telephone Number	:	417-876-3313

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	02/17/2022

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Directions to “EVANS DRUGS NEVADA LLC ” Practice Location

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