Provider Demographics
NPI:1255934519
Name:KALDAS, EVON A (RPH)
Entity type:Individual
Prefix:
First Name:EVON
Middle Name:A
Last Name:KALDAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2536 US 92 E
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-2601
Mailing Address - Country:US
Mailing Address - Phone:863-665-3171
Mailing Address - Fax:
Practice Address - Street 1:2536 US 92 E
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-2601
Practice Address - Country:US
Practice Address - Phone:863-665-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist