Provider Demographics
NPI:1306845730
Name:VICKERS, EVAN JAMES (RPH)
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:JAMES
Last Name:VICKERS
Suffix:
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 1:2166 N COBBLECREEK DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-9714
Mailing Address - Country:US
Mailing Address - Phone:435-586-4399
Mailing Address - Fax:435-586-3473
Practice Address - Street 1:91 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-2648
Practice Address - Country:US
Practice Address - Phone:435-586-9651
Practice Address - Fax:435-586-3473
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1436311701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist