Provider Demographics
NPI:1225240252
Name:EVANS, KRISTA SUE (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:SUE
Last Name:EVANS
Suffix:
Gender:F
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:EAST HWY 18 PHS INDIAN HOSPITAL
Mailing Address - Street 2:ATTN: PHARMACY
Mailing Address - City:PINE RIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57770-1201
Mailing Address - Country:US
Mailing Address - Phone:605-867-3192
Mailing Address - Fax:605-867-3279
Practice Address - Street 1:EAST HWY 18 PHS INDIAN HOSPITAL
Practice Address - Street 2:ATTN: PHARMACY
Practice Address - City:PINE RIDGE
Practice Address - State:SD
Practice Address - Zip Code:57770-1201
Practice Address - Country:US
Practice Address - Phone:605-867-3192
Practice Address - Fax:605-867-3279
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2012-05-15
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2012-05-15
Provider Licenses
StateLicense IDTaxonomies
WY2911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist