Organization
EVANS PHARMACY LLC
Active
Other names
EVANS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE KEITH WHITEHEAD (OWNER PHARMACIST)
(580) 234-4343
Entity
Organization
Contact information
Practice address
1106 W WILLOW RD, ENID, OK 73703-2503
(580) 234-4343
(580) 234-5477
Mailing address
1106 W WILLOW RD, ENID, OK 73703-2503
(580) 234-4343
(580) 234-5477
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
5-5107
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100232660E
—
OK
Enumeration date
04/04/2007
Last updated
08/27/2020
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