Provider Demographics
NPI:1497864359
Name:EVANS ENTERPRISES INC
Entity Type:Organization
Organization Name:EVANS ENTERPRISES INC
Other - Org Name:EVANS DRUG MART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH PD
Authorized Official - Phone:985-863-3100
Mailing Address - Street 1:64288 HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:LA
Mailing Address - Zip Code:70452-3602
Mailing Address - Country:US
Mailing Address - Phone:985-863-3100
Mailing Address - Fax:985-863-0790
Practice Address - Street 1:64288 HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:LA
Practice Address - Zip Code:70452-3602
Practice Address - Country:US
Practice Address - Phone:985-863-3100
Practice Address - Fax:985-863-0790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA29373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00330580Medicaid
LA1261831Medicaid