Provider Demographics
NPI:1932520186
Name:EVANS, MARIA-AUSILIA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARIA-AUSILIA
Middle Name:
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 1:5004 WINTER ST # 1
Mailing Address - Street 2:
Mailing Address - City:CARRABASSETT VALLEY
Mailing Address - State:ME
Mailing Address - Zip Code:04947-5822
Mailing Address - Country:US
Mailing Address - Phone:207-590-8867
Mailing Address - Fax:
Practice Address - Street 1:5004 WINTER ST # 1
Practice Address - Street 2:
Practice Address - City:CARRABASSETT VALLEY
Practice Address - State:ME
Practice Address - Zip Code:04947-5822
Practice Address - Country:US
Practice Address - Phone:207-590-8867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR13018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist