Provider Demographics
NPI:1740401843
Name:EVANS AND LYLE INC
Entity Type:Organization
Organization Name:EVANS AND LYLE INC
Other - Org Name:JONES PHARMACY AND HOME HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WD
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:509-838-3145
Mailing Address - Street 1:906 S MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-3836
Mailing Address - Country:US
Mailing Address - Phone:509-838-3145
Mailing Address - Fax:509-838-7438
Practice Address - Street 1:906 S MONROE ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-3836
Practice Address - Country:US
Practice Address - Phone:509-838-3145
Practice Address - Fax:509-838-7438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6025241Medicaid
WA4908630OtherNCPDP PROVIDER ID
WA4908630OtherNCPDP PROVIDER ID