1174848659 NPI number — DR. DONAVER MATHERLY EVANS II PHARMD

Table of content: DR. DONAVER MATHERLY EVANS II PHARMD (NPI 1174848659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174848659 NPI number — DR. DONAVER MATHERLY EVANS II PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVANS
Provider First Name:
DONAVER
Provider Middle Name:
MATHERLY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
II
Provider Credential Text:
PHARMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
E VANS
Provider Other First Name:
DONAVER
Provider Other Middle Name:
MATHERLY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
II
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1174848659
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10187 NC HWY 127 N
Provider Second Line Business Mailing Address:
ALEXANDER COUNTY
Provider Business Mailing Address City Name:
HICKORY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-495-3784
Provider Business Mailing Address Fax Number:
828-495-1264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10187 NC HWY 127
Provider Second Line Business Practice Location Address:
ALEXANDER COUNTY
Provider Business Practice Location Address City Name:
HICKORY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-495-3784
Provider Business Practice Location Address Fax Number:
828-495-1264
Provider Enumeration Date:
03/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  17545 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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