Provider Demographics
NPI:1609569276
Name:EVANS, ERIN ANDREA
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:ANDREA
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3330
Mailing Address - Country:US
Mailing Address - Phone:610-355-9244
Mailing Address - Fax:
Practice Address - Street 1:2180 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3330
Practice Address - Country:US
Practice Address - Phone:610-355-9244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPI125474183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician