Provider Demographics
NPI:1932482320
Name:TEWARI, GLORIA LAVERNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:LAVERNE
Last Name:TEWARI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:GLORIA
Other - Middle Name:LAVERNE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:2050 E OSCEOLA PKWY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-8602
Mailing Address - Country:US
Mailing Address - Phone:407-348-2323
Mailing Address - Fax:407-348-8799
Practice Address - Street 1:2050 E OSCEOLA PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-8602
Practice Address - Country:US
Practice Address - Phone:407-348-2323
Practice Address - Fax:407-348-8799
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist