Provider Demographics
NPI:1497096457
Name:EVANS, JENNIFER MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:EVANS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:ALVEAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:ESCALANTE
Mailing Address - State:UT
Mailing Address - Zip Code:84726-0276
Mailing Address - Country:US
Mailing Address - Phone:801-413-3718
Mailing Address - Fax:
Practice Address - Street 1:570 E MOQUI LN
Practice Address - Street 2:
Practice Address - City:ESCALANTE
Practice Address - State:UT
Practice Address - Zip Code:84726-7753
Practice Address - Country:US
Practice Address - Phone:435-826-4374
Practice Address - Fax:435-826-4372
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5328330-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist