Provider Demographics
NPI:1174030365
Name:DEJOIE, EVAN JOSEPH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:JOSEPH
Last Name:DEJOIE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16016 LEMOYNE BLVD APT 104
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-5168
Mailing Address - Country:US
Mailing Address - Phone:504-541-7225
Mailing Address - Fax:
Practice Address - Street 1:4031 POPPS FERRY RD STE A
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-2367
Practice Address - Country:US
Practice Address - Phone:228-392-7310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-14632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist