Provider Demographics
NPI:1386927408
Name:EVANS, PAMELA (PAMELA EVANS RPH)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:PAMELA EVANS RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-5013
Mailing Address - Country:US
Mailing Address - Phone:203-219-1356
Mailing Address - Fax:
Practice Address - Street 1:513 S FRONT ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-5013
Practice Address - Country:US
Practice Address - Phone:203-219-1356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-25
Last Update Date:2011-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20967183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist