Provider Demographics
NPI:1679885081
Name:EVANS, MATTHEW BRUCE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRUCE
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 1:2821 OAKMONT DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1004
Mailing Address - Country:US
Mailing Address - Phone:512-238-0475
Mailing Address - Fax:512-255-2367
Practice Address - Street 1:2821 OAKMONT DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1004
Practice Address - Country:US
Practice Address - Phone:512-238-0475
Practice Address - Fax:512-255-2367
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45091183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist