Detra Elaine Provost, RPH
NPI 1265703128ActiveIndividual· Pharmacist· Evans, GA
Pharmacist (RPH) in Evans, Georgia, licensed in GA, SC and TX, with an NPI issued in January 2012.
Overview
| NPI | 1265703128 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | RPH |
| Sole proprietor | No |
| NPI issued | Jan 24, 2012 |
| Last updated in NPPES | Jan 24, 2012 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Pharmacist Primary | 183500000X | RPH18214 | GA |
| Pharmacist | 183500000X | 8706 | SC |
| Pharmacist | 183500000X | 32754 | TX |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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