Provider Demographics
NPI:1073096749
Name:EVANS, TINA MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:MARIE
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 1:6250 E GRANT RD
Mailing Address - Street 2:SUITE #388
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-5811
Mailing Address - Country:US
Mailing Address - Phone:520-296-0317
Mailing Address - Fax:520-296-0417
Practice Address - Street 1:6250 E GRANT ROAD
Practice Address - Street 2:STE #388
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747
Practice Address - Country:US
Practice Address - Phone:520-296-0317
Practice Address - Fax:520-296-0417
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54923183500000X
AZS022450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist