Provider Demographics
NPI:1629353602
Name:EVANS, RUSSELL D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:D
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 1:8414 BLACK GUM ST
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-8899
Mailing Address - Country:US
Mailing Address - Phone:720-308-6206
Mailing Address - Fax:
Practice Address - Street 1:19028 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9381
Practice Address - Country:US
Practice Address - Phone:303-805-2135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15814183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist