Provider Demographics
NPI:1174278246
Name:EVANS, CHARLES ALBERT III (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ALBERT
Last Name:EVANS
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313-327 W. BALD EAGLE STREET
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745
Mailing Address - Country:US
Mailing Address - Phone:570-748-1790
Mailing Address - Fax:570-748-7631
Practice Address - Street 1:313-327 W BALD EAGLE ST
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745
Practice Address - Country:US
Practice Address - Phone:570-748-1790
Practice Address - Fax:570-748-7631
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP036605L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist