Provider Demographics
NPI:1255921599
Name:EVANS, DORTHY JEAN (DOCTOR OF PHARMACY)
Entity type:Individual
Prefix:DR
First Name:DORTHY
Middle Name:JEAN
Last Name:EVANS
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:DORTHY
Other - Middle Name:JEAN
Other - Last Name:TRIPLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DOCTOR OF PHARMACY
Mailing Address - Street 1:6505 N ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-2001
Mailing Address - Country:US
Mailing Address - Phone:618-394-8744
Mailing Address - Fax:618-394-1026
Practice Address - Street 1:6505 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-2001
Practice Address - Country:US
Practice Address - Phone:618-394-8744
Practice Address - Fax:618-394-2026
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.036497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist