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NPI Code Detail

MEDICARE: MR. JON EVENSON RPH

MEDICARE: MR. JON EVENSON RPH
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
1183500000XPharmacist115013MN

General Provider Information

NPI Number : 1467991422
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JON EVENSON RPH
Provider Business Mailing Address
First Line : 10501 FLORIDA AVE S
Second Line :
City : BLOOMINGTON
State : MN
Zip : 55438-2553
Country : US
Telephone Number : 952-854-1082
Fax Number :
Provider Business Practice Location Address
First Line : 10501 FLORIDA AVE S
Second Line :
City : BLOOMINGTON
State : MN
Zip : 55438-2553
Country : US
Telephone Number : 952-854-1082
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2017
Last Update Date : 02/22/2017

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