Healthcare Provider Details

I. General information

NPI: 1003187626
Provider Name (Legal Business Name): EVANGELIA DAVANOS PHARMD, CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 DEKALB AVE B231
BROOKLYN NY
11201-5425
US

IV. Provider business mailing address

121 DEKALB AVE B231
BROOKLYN NY
11201-5425
US

V. Phone/Fax

Practice location:
  • Phone: 718-250-8211
  • Fax: 718-250-6480
Mailing address:
  • Phone: 718-250-8211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number052244
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: