Victory Clairissa Elizabeth Evans, PHARMD
Individual provider Active NPI Pharmacist · Madison, FL
NPI 1831787563 · NPPES record last updated Jan 7, 2021
Key facts
- NPI
- 1831787563
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PS60265 (FL)
- Practice address
- 729 W Base St
Madison, FL 32340-1461 - Phone
- (850) 973-2719
- NPI assigned
- Jan 7, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS60265 | FL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS60265 | FL | Yes |
Addresses
Primary practice location
729 W Base St
Madison, FL 32340-1461
Mailing address
2303 SW Pettis Springs Cir
Greenville, FL 32331-3424
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881605250 | Other | FL | NPI |
Other providers in Madison, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 7, 2021. 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.