Provider Demographics
NPI:1407402092
Name:EVANS, NICHOLAS ROBERT (PHARMD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ROBERT
Last Name:EVANS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2706 W 79TH ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3915
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18555 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-2725
Practice Address - Country:US
Practice Address - Phone:913-489-3459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-10
Last Update Date:2019-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-107653183500000X
MO2019028168183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist