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MRS. DETRA ELAINE PROVOST RPH
NPI 1265703128
Pharmacist in Evans, GA

Active since January 24, 2012
4223 WASHINGTON RD, EVANS, GA 30809(706) 869-0937(706) 993-9781 Get Directions Write a Review

NPPES record last updated: January 24, 2012. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Mrs. Detra Elaine Provost Rph NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. DETRA ELAINE PROVOST RPH (NPI 1265703128) is an individual pharmacist in Evans, Georgia, licensed in Georgia (RPH18214) and active in the NPI registry since January 2012.

NPPES Registry Identity

NPI1265703128
Entity TypeIndividualFemale
Primary Taxonomy183500000X
Provider Legal NameMRS. DETRA ELAINE PROVOSTCredential: RPH
Location Address4223 WASHINGTON RDEvans, GA 30809-3069
Mailing Address114 Aberdeen DrAiken, SC 29803-7100 · (803) 649-3603 · Fax (803) 649-3603
Phone(706) 869-0937
Fax(706) 993-9781
Sole ProprietorNo
Enumeration DateJanuary 24, 2012
✔ NPI 1265703128 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPharmacistPharmacy Service Providers
Taxonomy Code183500000X
Licenses✔ Licensed in GA · RPH18214✔ Licensed in SC · 8706✔ Licensed in TX · 32754
Definition
An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care.
4223 WASHINGTON RD, Evans, GA 30809
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Other Names 1

Former Name (1)Mrs. Detra Elaine Wooten Rph

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GEORGIA CVS PHARMACY LLC
Pharmacy
4223 WASHINGTON RD
EVANS, GA 30809
Columbia County (706) 869-0937
WANETTE HAIZE NEWBY PHARM.D
Pharmacist
4223 WASHINGTON RD
EVANS, GA 30809
Columbia County (706) 869-0937

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Detra Provost's NPI number?

The NPI number for Detra Provost is 1265703128. It was assigned to this individual provider in the NPPES registry on January 24, 2012. The provider is also known as Mrs. Detra Elaine Wooten Rph.

Where is Detra Provost located?

Detra Provost practices at 4223 Washington Rd, Evans, GA 30809. The listed phone number is (706) 869-0937.

What is Detra Provost's specialty?

The primary specialty registered for this NPI is Pharmacist with taxonomy code 183500000X.

When was this NPI record last updated?

The NPPES record for Detra Provost was last updated on January 24, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.