NPIMap

Organization Active NPI

Evans Pharmacy LLC

  • Community/Retail Pharmacy
  • Enid, OK
National Provider Identifier
1346274693
Registry record updated Aug 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5-5107 Issued in OK
Legal business name
EVANS PHARMACY LLC
Practice address
1106 W Willow Rd
Enid, OK 73703-2503
Phone
(580) 234-4343
Fax
(580) 234-5477
NPI assigned
Jul 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kristi Lynn Nunley
Title
Office Manager
Phone
(580) 234-4343

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 5-5107 OK
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X 5-5107 OK
Pharmacy 333600000X 5-5107 OK
Community/Retail Pharmacy 3336C0003X 5-5107 OK Primary
Long Term Care Pharmacy 3336L0003X 5-5107 OK

Addresses

Primary practice location

1106 W Willow Rd
Enid, OK 73703-2503

Mailing address

1106 W Willow Rd
Enid, OK 73703-2503
Phone (580) 234-4343

Other identifiers 1

IdentifierTypeStateIssuer
100247450AMedicaidOK

Other names 1

  • Evans Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051222000625 OK Part B Supplier - Pharmacy 5092737668 Practice locations: Enid, OK

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Evans Pharmacy LLC12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629331200000",
    "number": "1346274693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1106 W WILLOW RD",
            "city": "ENID",
            "state": "OK",
            "postal_code": "737032503",
            "telephone_number": "580-234-4343",
            "fax_number": "580-234-5477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 W WILLOW RD",
            "city": "ENID",
            "state": "OK",
            "postal_code": "737032503",
            "telephone_number": "580-234-4343",
            "fax_number": "580-234-5477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVANS PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A",
        "authorized_official_last_name": "NUNLEY",
        "authorized_official_first_name": "KRISTI",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "580-234-4343"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "OK",
            "license": "5-5107",
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "OK",
            "license": "5-5107",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "OK",
            "license": "5-5107",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OK",
            "license": "5-5107",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "OK",
            "license": "5-5107",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100247450A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evans Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Evans Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Enid, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.