Provider Demographics
NPI:1093977308
Name:EVANS DRUGS SEDALIA EAST LLC
Entity Type:Organization
Organization Name:EVANS DRUGS SEDALIA EAST LLC
Other - Org Name:WOODS PHARAMCY 2470
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMMERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-876-3313
Mailing Address - Street 1:209 E US HIGHWAY 54
Mailing Address - Street 2:
Mailing Address - City:EL DORADO SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64744-1925
Mailing Address - Country:US
Mailing Address - Phone:417-876-3313
Mailing Address - Fax:417-876-2326
Practice Address - Street 1:701 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-6040
Practice Address - Country:US
Practice Address - Phone:660-827-2643
Practice Address - Fax:660-827-3215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO606377307Medicaid
2049649OtherPK
5712990005Medicare NSC