=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801165451
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMMANUELLE O'LAVIN PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2011
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8951 HUDSON AVE
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34667-8030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-869-7224
-----------------------------------------------------
Fax | 727-869-7099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8951 HUDSON AVE
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34667-8030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-869-7224
-----------------------------------------------------
Fax | 727-869-7099
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 68681
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS46166
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------