Provider Demographics
NPI:1174263495
Name:ARCHER, EVAN PARKER (PHARMD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:PARKER
Last Name:ARCHER
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 1:32 EDGEMOOR RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-3918
Mailing Address - Country:US
Mailing Address - Phone:617-460-5666
Mailing Address - Fax:
Practice Address - Street 1:655 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2017
Practice Address - Country:US
Practice Address - Phone:617-744-0842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH240260183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist