Provider Demographics
NPI:1356487292
Name:TAVAREZ, EVEREDITH Y (RPH)
Entity Type:Individual
Prefix:MRS
First Name:EVEREDITH
Middle Name:Y
Last Name:TAVAREZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SA-12 CALLE PASEO DE LAS FLORES
Mailing Address - Street 2:URBANIZACION PRIMAVERA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SA-12 CALLE PASEO DE LAS FLORES
Practice Address - Street 2:URBANIZACION PRIMAVERA
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-293-2669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist