Provider Demographics
NPI:1750473633
Name:EVANS, THOMAS D JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:D
Last Name:EVANS
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 WINDY KNOB LN
Mailing Address - Street 2:
Mailing Address - City:APPOMATTOX
Mailing Address - State:VA
Mailing Address - Zip Code:24522-8398
Mailing Address - Country:US
Mailing Address - Phone:434-352-5967
Mailing Address - Fax:
Practice Address - Street 1:2223 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-4511
Practice Address - Country:US
Practice Address - Phone:434-846-8481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004231183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist