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Organization

EVANS PHARMACY LLC

Active
Other names
Evans Pharmacy Viatl Care
Organization subpart
No

Provider details

NPI number
Authorized official
KYLE WHITEHEAD (PARTNER)
(580) 234-4343
Entity
Organization

Contact information

Practice address
1106 W WILLOW RD, ENID, OK 73703-2503
(508) 234-4343
(580) 234-5477
Mailing address
PO BOX 5047, MERIDIAN, MS 39302-5047
(800) 447-4095
(601) 482-7490

Taxonomy

Speciality
Code
Description
License number
State
3336H0001X
Home Infusion Therapy Pharmacy
Primary
5-4603
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100232660E
OK
05
100247450A
OK
01
100247450C
OK HEALTHCARE AUTHORITY
OK
01
37143288001
BCBS HIT
OK
Enumeration date
07/19/2006
Last updated
08/22/2020
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