Provider Demographics
NPI:1376838128
Name:EAVES, PAMELA J (RPH)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:EAVES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54B SE 1ST LN
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:MO
Mailing Address - Zip Code:64759-9226
Mailing Address - Country:US
Mailing Address - Phone:417-682-5838
Mailing Address - Fax:417-682-5811
Practice Address - Street 1:54B SE 1ST LN
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:MO
Practice Address - Zip Code:64759-9226
Practice Address - Country:US
Practice Address - Phone:417-682-5838
Practice Address - Fax:417-682-5811
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO42550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist