Provider Demographics
NPI:1336595743
Name:EVANS, GERALD J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:J
Last Name:EVANS
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 1:3560 W CAMP WISDOM RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-2506
Mailing Address - Country:US
Mailing Address - Phone:214-266-1300
Mailing Address - Fax:
Practice Address - Street 1:3560 W CAMP WISDOM RD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-2506
Practice Address - Country:US
Practice Address - Phone:214-266-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33341183500000X
TX47137183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist