Provider Demographics
NPI:1609569276
Name:EVANS, ERIN ANDREA
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:ANDREA
Last Name:EVANS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1496 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1020
Mailing Address - Country:US
Mailing Address - Phone:267-884-5027
Mailing Address - Fax:
Practice Address - Street 1:613 FAYETTE STREET
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1704
Practice Address - Country:US
Practice Address - Phone:610-238-4763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP459036183500000X
PAPI125474183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No183700000XPharmacy Service ProvidersPharmacy Technician