Provider Demographics
NPI:1053608794
Name:KWAN, EVELYN (PHARMD)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:KWAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 WOODLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-3010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:191 WOODLAND PKWY
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-3010
Practice Address - Country:US
Practice Address - Phone:760-471-9007
Practice Address - Fax:760-471-9785
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51368183500000X
WA00021314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist