Provider Demographics
NPI:1598913147
Name:EVANS PHARMACY LLC
Entity Type:Organization
Organization Name:EVANS PHARMACY LLC
Other - Org Name:EVANS EXPRESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:NUNLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-234-4343
Mailing Address - Street 1:110 N OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-4946
Mailing Address - Country:US
Mailing Address - Phone:580-234-4343
Mailing Address - Fax:580-233-1208
Practice Address - Street 1:110 N OAKWOOD RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-4946
Practice Address - Country:US
Practice Address - Phone:580-233-1202
Practice Address - Fax:580-233-1208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
OK5-71373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2116853OtherPK
OK100247450DMedicaid
OK100247450DMedicaid