Provider Demographics
NPI:1437431699
Name:ETOH, EVELYN
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:
Last Name:ETOH
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 1:356 STREAMVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-6407
Mailing Address - Country:US
Mailing Address - Phone:407-312-3254
Mailing Address - Fax:
Practice Address - Street 1:356 STREAMVIEW WAY
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-6407
Practice Address - Country:US
Practice Address - Phone:407-312-3254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist