Provider Demographics
NPI:1649051707
Name:EVANKO, LAUREN LEIGH I (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:LEIGH
Last Name:EVANKO
Suffix:I
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 1:254 ARGYLE RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-2914
Mailing Address - Country:US
Mailing Address - Phone:860-790-4331
Mailing Address - Fax:
Practice Address - Street 1:240 INDIAN RIVER RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3649
Practice Address - Country:US
Practice Address - Phone:475-209-9284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0016211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist