Provider Demographics
NPI:1518338201
Name:EVENSON, JULIE SCHWARTZ (RPH)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:SCHWARTZ
Last Name:EVENSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 FAWN DR
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-6448
Mailing Address - Country:US
Mailing Address - Phone:406-799-1191
Mailing Address - Fax:406-727-1028
Practice Address - Street 1:2800 11TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5263
Practice Address - Country:US
Practice Address - Phone:406-727-0070
Practice Address - Fax:406-727-1028
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTPHA-PHA-LIC-3504OtherMONTANA STATE PHARMACY LICENSE