Provider Demographics
NPI:1184102428
Name:EVANS, ADAM W (PHARMD)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:W
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:PO BOX 1209
Mailing Address - Street 2:
Mailing Address - City:YANCEYVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27379-1209
Mailing Address - Country:US
Mailing Address - Phone:336-694-4104
Mailing Address - Fax:336-694-5823
Practice Address - Street 1:1493 MAIN ST
Practice Address - Street 2:
Practice Address - City:YANCEYVILLE
Practice Address - State:NC
Practice Address - Zip Code:27379-8793
Practice Address - Country:US
Practice Address - Phone:336-694-4104
Practice Address - Fax:336-694-5823
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist