Provider Demographics
NPI:1083119994
Name:EVANS, TIMOTHY WARREN (RPH, MS)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:WARREN
Last Name:EVANS
Suffix:
Gender:M
Credentials:RPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2714 HARBECK RD
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5630
Mailing Address - Country:US
Mailing Address - Phone:541-476-0361
Mailing Address - Fax:
Practice Address - Street 1:2714 HARBECK RD
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5630
Practice Address - Country:US
Practice Address - Phone:541-476-0361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-24
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61191835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR6119OtherSTATE BOARD OF PHARMACY