Provider Demographics
NPI:1538465778
Name:EVANS, SEAN GREGORY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:GREGORY
Last Name:EVANS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7607 HIDDEN RIVER TRCE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47111-8788
Mailing Address - Country:US
Mailing Address - Phone:812-569-6668
Mailing Address - Fax:
Practice Address - Street 1:1250 PATROL RD
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-8670
Practice Address - Country:US
Practice Address - Phone:855-647-7379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-06
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20573183500000X
ARPD15159183500000X
IN26023986A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist