Provider Demographics
NPI:1518271170
Name:EVANS, CODY
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 WESTGATE PLZ
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-9012
Mailing Address - Country:US
Mailing Address - Phone:828-369-5023
Mailing Address - Fax:847-396-3155
Practice Address - Street 1:395 WESTGATE PLZ
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-9012
Practice Address - Country:US
Practice Address - Phone:828-369-5023
Practice Address - Fax:847-396-3155
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46254183500000X
NC25582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist