Provider Demographics
NPI:1376985689
Name:EVANS, ERICA MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:MARIE
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 1:655 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37015-1403
Mailing Address - Country:US
Mailing Address - Phone:615-792-5135
Mailing Address - Fax:615-792-6947
Practice Address - Street 1:655 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHLAND CITY
Practice Address - State:TN
Practice Address - Zip Code:37015-1403
Practice Address - Country:US
Practice Address - Phone:615-792-5135
Practice Address - Fax:615-792-6947
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-28
Last Update Date:2013-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist