Provider Demographics
NPI:1093776213
Name:EVANS, TIMOTHY DALE (PHARMD, R PH,)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DALE
Last Name:EVANS
Suffix:
Gender:M
Credentials:PHARMD, R PH,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 LYON DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1066
Mailing Address - Country:US
Mailing Address - Phone:859-229-6051
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE STREET
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40535
Practice Address - Country:US
Practice Address - Phone:859-323-5641
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist