Provider Demographics
NPI:1982713004
Name:GUADALUPE, EVELYN (RPH)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:GUADALUPE
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 1:8101 SW 158TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-3033
Mailing Address - Country:US
Mailing Address - Phone:305-575-3250
Mailing Address - Fax:305-387-3604
Practice Address - Street 1:1201 NW 16TH ST
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1624
Practice Address - Country:US
Practice Address - Phone:305-575-3250
Practice Address - Fax:305-387-3604
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 32941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist