Provider Demographics
NPI:1578167631
Name:EAPEN, MINI (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MINI
Middle Name:
Last Name:EAPEN
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 1:970 CYPRESS GDN BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4636
Mailing Address - Country:US
Mailing Address - Phone:863-294-3138
Mailing Address - Fax:
Practice Address - Street 1:970 CYPRESS GARDEN BLVD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4636
Practice Address - Country:US
Practice Address - Phone:863-294-3138
Practice Address - Fax:863-291-0499
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist