Organization
EVANS TOTAL CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID STEWART PRATER JR. PHARM D. (OWNER)
(270) 472-2984
Entity
Organization
Contact information
Practice address
208 LAKE ST, FULTON, KY 42041-1544
(270) 472-2984
(270) 472-9377
Mailing address
208 LAKE ST, FULTON, KY 42041-1544
(270) 472-2984
(270) 472-9377
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
MG0530
KY
333600000X
Pharmacy
MG0530
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000298324
ANTHEM BCBS
KY
05
—
1454274
—
TN
01
—
4067258
BCBS TN
TN
05
—
90005596
—
KY
Enumeration date
07/04/2006
Last updated
11/20/2011
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