Provider Demographics
NPI:1255612362
Name:EVANS, JOHN GLENN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:GLENN
Last Name:EVANS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 OLD GREENVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-1788
Mailing Address - Country:US
Mailing Address - Phone:864-653-6185
Mailing Address - Fax:864-653-9561
Practice Address - Street 1:501 OLD GREENVILLE HWY
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-1788
Practice Address - Country:US
Practice Address - Phone:864-653-6185
Practice Address - Fax:864-653-9561
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist