Provider Demographics
NPI:1972872125
Name:CHASKO, ELIZABETH LEE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LEE
Last Name:CHASKO
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 1:2891 UPPER PARK RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6128
Mailing Address - Country:US
Mailing Address - Phone:407-312-3025
Mailing Address - Fax:
Practice Address - Street 1:955 S WINTER PARK DR
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5437
Practice Address - Country:US
Practice Address - Phone:407-767-7002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS27669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist