Provider Demographics
NPI:1154660629
Name:EVELYN, VICTORIA LOUISE (PHARMD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LOUISE
Last Name:EVELYN
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 1:1000 DEER SPRING DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-2555
Mailing Address - Country:US
Mailing Address - Phone:904-327-0957
Mailing Address - Fax:904-378-0456
Practice Address - Street 1:1000 DEER SPRING DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-2555
Practice Address - Country:US
Practice Address - Phone:904-327-0957
Practice Address - Fax:904-378-0456
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist