Provider Demographics
NPI:1558510354
Name:EVANS, LAURA G (PHARM D)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:G
Last Name:EVANS
Suffix:
Gender:F
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 1:2 CANFIELD AVE
Mailing Address - Street 2:#332
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-2046
Mailing Address - Country:US
Mailing Address - Phone:617-872-3661
Mailing Address - Fax:
Practice Address - Street 1:275 MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-2410
Practice Address - Country:US
Practice Address - Phone:914-285-0690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052998183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist