Provider Demographics
NPI:1871830570
Name:EVANS, DONALD (DPH)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2246 KEENLAND COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-3909
Mailing Address - Country:US
Mailing Address - Phone:615-617-3296
Mailing Address - Fax:
Practice Address - Street 1:2246 KEENLAND COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37127-3909
Practice Address - Country:US
Practice Address - Phone:615-617-3296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist