Provider Demographics
NPI:1881972420
Name:EVANS, KATHERINE BETH (PHARMD, BCPS, AE-C)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:BETH
Last Name:EVANS
Suffix:
Gender:F
Credentials:PHARMD, BCPS, AE-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4036
Mailing Address - Country:US
Mailing Address - Phone:701-780-3457
Mailing Address - Fax:701-780-3442
Practice Address - Street 1:1200 S COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4044
Practice Address - Country:US
Practice Address - Phone:701-780-3444
Practice Address - Fax:701-780-3442
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120590183500000X
ND5382183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND21627Medicaid
MN272489000Medicaid