Provider Demographics
NPI:1154356939
Name:EVANS, JESSICA L (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:L
Last Name:EVANS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10250 STAPLES MILL RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3064
Mailing Address - Country:US
Mailing Address - Phone:804-755-6207
Mailing Address - Fax:804-755-7133
Practice Address - Street 1:10250 STAPLES MILL RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3064
Practice Address - Country:US
Practice Address - Phone:804-755-6207
Practice Address - Fax:804-755-7133
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202204269183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist