Provider Demographics
NPI:1518041532
Name:EVANS, JOHN M (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:EVANS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 NE 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3027
Mailing Address - Country:US
Mailing Address - Phone:503-899-9253
Mailing Address - Fax:503-216-0630
Practice Address - Street 1:179 NE 11TH AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3027
Practice Address - Country:US
Practice Address - Phone:503-899-9253
Practice Address - Fax:503-216-0630
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist