Provider Demographics
NPI:1093135337
Name:SEVILLA, CARMELITA GARZON
Entity Type:Individual
Prefix:
First Name:CARMELITA
Middle Name:GARZON
Last Name:SEVILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 V ERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ST CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-2249
Mailing Address - Country:US
Mailing Address - Phone:407-892-6337
Mailing Address - Fax:
Practice Address - Street 1:319 VERMONT AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-2249
Practice Address - Country:US
Practice Address - Phone:407-892-6337
Practice Address - Fax:407-892-6337
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS21467183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist