Provider Demographics
NPI:1245508951
Name:MAUGHAN, EVAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:
Last Name:MAUGHAN
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 1:3300 DILLON DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1040
Mailing Address - Country:US
Mailing Address - Phone:719-696-6685
Mailing Address - Fax:
Practice Address - Street 1:2921 N NEVADA AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6224
Practice Address - Country:US
Practice Address - Phone:719-471-3440
Practice Address - Fax:719-471-8437
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist