Healthcare Provider Details

I. General information

NPI: 1881709491
Provider Name (Legal Business Name): TERRY CONSTANTINE EVANGELIOU RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

4416 ALTON RD
MIAMI BEACH FL
33140-2851
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-3243
  • Fax: 305-575-7502
Mailing address:
  • Phone: 305-532-4493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS29979
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302025065
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: