Provider Demographics
NPI:1326030933
Name:EVANS, JEFFERY D (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:D
Last Name:EVANS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 BELLE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-6004
Mailing Address - Country:US
Mailing Address - Phone:800-225-5455
Mailing Address - Fax:
Practice Address - Street 1:1724 BELLE ISLAND RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-6004
Practice Address - Country:US
Practice Address - Phone:800-225-5455
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021872183500000X
TX409681835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy