Provider Demographics
NPI:1073809638
Name:EVANS, MOLLY M (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:M
Last Name:EVANS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 WADE HAMPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-2789
Mailing Address - Country:US
Mailing Address - Phone:864-292-2014
Mailing Address - Fax:
Practice Address - Street 1:3027 WADE HAMPTON BLVD
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-2789
Practice Address - Country:US
Practice Address - Phone:864-292-2014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12868183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist