Provider Demographics
NPI:1982379756
Name:SIPOS, EVAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:SIPOS
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 1:3111 TRIMBLESTONE LN APT 204
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-5941
Mailing Address - Country:US
Mailing Address - Phone:724-989-9629
Mailing Address - Fax:
Practice Address - Street 1:4441 SIX FORKS RD STE 110
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5729
Practice Address - Country:US
Practice Address - Phone:919-787-1155
Practice Address - Fax:919-787-1158
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist