Provider Demographics
NPI:1952044737
Name:EVERAERT, ELISE LUTGARDE
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:LUTGARDE
Last Name:EVERAERT
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 1:4400 S HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5383
Mailing Address - Country:US
Mailing Address - Phone:352-394-8029
Mailing Address - Fax:
Practice Address - Street 1:4400 S HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5383
Practice Address - Country:US
Practice Address - Phone:352-394-8029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS63911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist