Provider Demographics
NPI:1548818305
Name:STRAKE, EVAN J (PHARM D)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:J
Last Name:STRAKE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1591 MARY TODD LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-6676
Mailing Address - Country:US
Mailing Address - Phone:618-660-5442
Mailing Address - Fax:
Practice Address - Street 1:11550 PAGE SERVICE DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3509
Practice Address - Country:US
Practice Address - Phone:314-344-9201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019032323183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist