Provider Demographics
NPI:1003220369
Name:EVERSANA LIFE SCIENCE SERVICES, LLC
Entity Type:Organization
Organization Name:EVERSANA LIFE SCIENCE SERVICES, LLC
Other - Org Name:DOHMEN LIFE SCIENCE SERVICES, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP CONTRACTING AND PAYER ACCESS
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-519-4951
Mailing Address - Street 1:17877 CHESTERFIELD AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1211
Mailing Address - Country:US
Mailing Address - Phone:636-519-2400
Mailing Address - Fax:866-862-8818
Practice Address - Street 1:17877 CHESTERFIELD AIRPORT RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1211
Practice Address - Country:US
Practice Address - Phone:636-519-2400
Practice Address - Fax:866-862-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251F00000X
MO20140001853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
2635956OtherNCPDP
2635956OtherNCPDP