Provider Demographics
NPI:1023858305
Name:DE ROSA, EVE MARIE (PHARMACY INTERN)
Entity type:Individual
Prefix:
First Name:EVE
Middle Name:MARIE
Last Name:DE ROSA
Suffix:
Gender:F
Credentials:PHARMACY INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 ROBIN RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896-4749
Mailing Address - Country:US
Mailing Address - Phone:315-706-9735
Mailing Address - Fax:
Practice Address - Street 1:2855 N OLD LAKE WILSON RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-1821
Practice Address - Country:US
Practice Address - Phone:407-606-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-25
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL447181835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist