Provider Demographics
NPI:1659407435
Name:EVANS, SHIRLEY JEAN (RPH)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:JEAN
Last Name:EVANS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25740 BERRYHILL RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-9603
Mailing Address - Country:US
Mailing Address - Phone:907-694-5488
Mailing Address - Fax:
Practice Address - Street 1:4900 EAGLE ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7446
Practice Address - Country:US
Practice Address - Phone:907-762-0204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK7261835G0303X
WAPH000104211835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric