Provider Demographics
NPI:1922378231
Name:EVANS, JUDITH (RPH)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:HIPPERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:4351 EAST HWY 90
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635
Mailing Address - Country:US
Mailing Address - Phone:520-458-0997
Mailing Address - Fax:520-458-5849
Practice Address - Street 1:4351 E HWY 90
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2431
Practice Address - Country:US
Practice Address - Phone:520-458-0997
Practice Address - Fax:520-458-5849
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS013545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist