Provider Demographics
NPI:1407280845
Name:EVANS, EBONI M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EBONI
Middle Name:M
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 1:12125 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-3000
Mailing Address - Country:US
Mailing Address - Phone:985-785-9054
Mailing Address - Fax:985-785-8772
Practice Address - Street 1:12125 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-3000
Practice Address - Country:US
Practice Address - Phone:985-785-9054
Practice Address - Fax:985-785-8772
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist