Provider Demographics
NPI:1437734951
Name:DEZEEUW, EVAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:DEZEEUW
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 1:36703 SE SUNSET VIEW RD
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-6768
Mailing Address - Country:US
Mailing Address - Phone:513-604-6603
Mailing Address - Fax:
Practice Address - Street 1:36703 SE SUNSET VIEW RD
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-6768
Practice Address - Country:US
Practice Address - Phone:513-604-6603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0015883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist