Provider Demographics
NPI:1760831788
Name:ELOISIN, WOODLYNE
Entity Type:Individual
Prefix:
First Name:WOODLYNE
Middle Name:
Last Name:ELOISIN
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 1:9824 S MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-3201
Mailing Address - Country:US
Mailing Address - Phone:561-732-9115
Mailing Address - Fax:561-732-5216
Practice Address - Street 1:9824 S MILITARY TRL
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-3201
Practice Address - Country:US
Practice Address - Phone:561-732-9115
Practice Address - Fax:561-732-5216
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS44109OtherPHARMACIST