Brian Evans
Individual provider Active NPI Pharmacist · Augusta, WI
NPI 1649883919 · NPPES record last updated Aug 26, 2020
Key facts
- NPI
- 1649883919
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 10166 (WI)
- Practice address
- 153 W Lincoln St
Augusta, WI 54722-9152 - Phone
- (715) 286-2515
- NPI assigned
- Aug 26, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10166 | WI | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 10166 | WI | Yes |
Addresses
Primary practice location
153 W Lincoln St
Augusta, WI 54722-9152
Mailing address
1324 W Clairemont Ave Ste 3
Eau Claire, WI 54701-6191
Other providers in Augusta, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 26, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.