Provider Demographics
NPI:1619578556
Name:EVANS, WILLIAM JOSEPH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:EVANS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 RIVERSHYRE CIR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-6438
Mailing Address - Country:US
Mailing Address - Phone:177-068-2112
Mailing Address - Fax:
Practice Address - Street 1:3250 SARDIS CHURCH RD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-6019
Practice Address - Country:US
Practice Address - Phone:678-546-6406
Practice Address - Fax:678-546-6454
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist