Provider Demographics
NPI:1417958539
Name:EVANCIC, KEVIN PAUL (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:PAUL
Last Name:EVANCIC
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 CASTLE SHANNON BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15234-1601
Mailing Address - Country:US
Mailing Address - Phone:124-561-2417
Mailing Address - Fax:412-561-7418
Practice Address - Street 1:799 CASTLE SHANNON BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15234-1601
Practice Address - Country:US
Practice Address - Phone:124-561-2417
Practice Address - Fax:412-561-7418
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist