Provider Demographics
NPI:1396178042
Name:CHONTOS, EVAN M (PHARMD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:M
Last Name:CHONTOS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MALL BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2213
Mailing Address - Country:US
Mailing Address - Phone:800-238-7828
Mailing Address - Fax:
Practice Address - Street 1:105 MALL BLVD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2213
Practice Address - Country:US
Practice Address - Phone:800-238-7828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS020053183500000X
PARP450133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist