Provider Demographics
NPI:1396175865
Name:EVANS, NATHANIAL (RPH, PHARMD)
Entity type:Individual
Prefix:DR
First Name:NATHANIAL
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 BASHFORD MANOR LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2114
Mailing Address - Country:US
Mailing Address - Phone:502-451-6822
Mailing Address - Fax:
Practice Address - Street 1:2020 BASHFORD MANOR LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-2114
Practice Address - Country:US
Practice Address - Phone:502-451-6822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY016169183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY464408OtherNABP
KY016169OtherKENTUCKY PHARMACIST LICENSE