Provider Demographics
NPI:1548382286
Name:EVANS, MATTHEW DYLAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:DYLAN
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:PO BOX 1241
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-1241
Mailing Address - Country:US
Mailing Address - Phone:928-329-2795
Mailing Address - Fax:928-329-0337
Practice Address - Street 1:2600 W 16TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4214
Practice Address - Country:US
Practice Address - Phone:928-329-2795
Practice Address - Fax:928-329-0337
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11960183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ11960OtherSTATE LICENSE