Provider Demographics
NPI:1003179938
Name:EVANS, TIMOTHY RAY (RPH)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RAY
Last Name:EVANS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21801 MAKAH RD
Mailing Address - Street 2:
Mailing Address - City:WOODWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98020-7204
Mailing Address - Country:US
Mailing Address - Phone:425-778-4306
Mailing Address - Fax:
Practice Address - Street 1:21801 MAKAH ROAD
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:WA
Practice Address - Zip Code:98020-7204
Practice Address - Country:US
Practice Address - Phone:425-778-4306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist