Provider Demographics
NPI:1992042675
Name:OLIVE, EVE L
Entity Type:Individual
Prefix:
First Name:EVE
Middle Name:L
Last Name:OLIVE
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 1:2750 RACE TRACK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3227
Mailing Address - Country:US
Mailing Address - Phone:904-230-3965
Mailing Address - Fax:904-230-3977
Practice Address - Street 1:2750 RACE TRACK RD
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-3227
Practice Address - Country:US
Practice Address - Phone:904-230-3965
Practice Address - Fax:904-230-3977
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33931183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist