Provider Demographics
NPI:1801174412
Name:MCEVOY, JEANNE L
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:L
Last Name:MCEVOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 DOW RD
Mailing Address - Street 2:
Mailing Address - City:CAROLINA BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28428-4514
Mailing Address - Country:US
Mailing Address - Phone:910-458-3060
Mailing Address - Fax:910-458-2782
Practice Address - Street 1:901 DOW RD
Practice Address - Street 2:
Practice Address - City:CAROLINA BEACH
Practice Address - State:NC
Practice Address - Zip Code:28428-4514
Practice Address - Country:US
Practice Address - Phone:910-458-3060
Practice Address - Fax:910-458-2782
Is Sole Proprietor?:No
Enumeration Date:2011-07-31
Last Update Date:2011-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist