Provider Demographics
NPI:1841747276
Name:MEDFORD, EVAN CHRISTOPHER (PHARMD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:CHRISTOPHER
Last Name:MEDFORD
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 1:4211 NC 11 S
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-8960
Mailing Address - Country:US
Mailing Address - Phone:252-215-0467
Mailing Address - Fax:
Practice Address - Street 1:4211 NC 11 S
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-8960
Practice Address - Country:US
Practice Address - Phone:252-215-0467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist