Provider Demographics
NPI:1518377142
Name:SOUTH, EVELYN VIRGINIA I (PHARMD)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:VIRGINIA
Last Name:SOUTH
Suffix:I
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120B VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-7038
Mailing Address - Country:US
Mailing Address - Phone:270-670-7793
Mailing Address - Fax:
Practice Address - Street 1:600 31-W BYPASS
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-7038
Practice Address - Country:US
Practice Address - Phone:202-360-2301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013263183500000X
AZ14362183500000X
TN34240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist