MEDICARE: MRS. MINI EAPEN RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS39875	FL

General Provider Information

NPI Number	:	1578167631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MINI EAPEN RPH

Provider Business Mailing Address
First Line	:	970 CYPRESS GDN BLVD
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-4636
Country	:	US
Telephone Number	:	863-294-3138
Fax Number	:

Provider Business Practice Location Address
First Line	:	970 CYPRESS GARDEN BLVD
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-4636
Country	:	US
Telephone Number	:	863-294-3138
Fax Number	:	863-291-0499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2020
Last Update Date	:	11/29/2020

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Directions to “ MRS. MINI EAPEN RPH” Practice Location

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