Provider Demographics
NPI:1619055860
Name:EVETTS PHARMACY INC.
Entity Type:Organization
Organization Name:EVETTS PHARMACY INC.
Other - Org Name:THE MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:EVETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-683-3511
Mailing Address - Street 1:920 ESTATE DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0601
Mailing Address - Country:US
Mailing Address - Phone:901-683-3511
Mailing Address - Fax:
Practice Address - Street 1:920 ESTATE DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0601
Practice Address - Country:US
Practice Address - Phone:901-683-3511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4401650OtherNCPDP #
TN4674470001Medicaid
TN4674470001Medicaid
TN4674470001Medicare NSC