Provider Demographics
NPI:1831645118
Name:ENDICOTT, EVAN LAWSON (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:LAWSON
Last Name:ENDICOTT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:MR
Other - First Name:EVAN
Other - Middle Name:TAYLOR
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:740 SOUTH LIMESTONE
Mailing Address - Street 2:J134
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536
Mailing Address - Country:US
Mailing Address - Phone:859-323-5855
Mailing Address - Fax:859-323-1056
Practice Address - Street 1:740 SOUTH LIMESTONE
Practice Address - Street 2:J134
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536
Practice Address - Country:US
Practice Address - Phone:859-323-5855
Practice Address - Fax:859-323-1056
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY018718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist