Healthcare Provider Details

I. General information

NPI: 1093626962
Provider Name (Legal Business Name): GENE BANAWAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 AVENUE F NE
WINTER HAVEN FL
33881-4131
US

IV. Provider business mailing address

638 ARBOR POINTE AVE
MINNEOLA FL
34715-6048
US

V. Phone/Fax

Practice location:
  • Phone: 863-293-1121
  • Fax:
Mailing address:
  • Phone: 352-201-8157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS70833
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: