Provider Demographics
NPI:1780332742
Name:KAVAS, TONYA (RPH)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:KAVAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:53076 TRINITY CT
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-7634
Mailing Address - Country:US
Mailing Address - Phone:574-220-1420
Mailing Address - Fax:
Practice Address - Street 1:3900 E BRISTOL ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-4584
Practice Address - Country:US
Practice Address - Phone:574-970-0004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018002A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty