Organization
EVASON PHARMACIES INC
Active
Other names
SAM'S PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN WILSON RPH (OWNER)
(910) 285-2937
Entity
Organization
Contact information
Practice address
110 S SYCAMORE ST, ROSE HILL, NC 28458
(910) 289-4271
(910) 289-3880
Mailing address
PO BOX 1086, ROSE HILL, NC 28458-1086
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
07544
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0315432
—
NC
01
—
3431690
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/21/2006
Last updated
01/31/2013
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