MEDICARE: EVANGELINE PAVLAKOS 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	RP00004489	NM

General Provider Information

NPI Number	:	1336457878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVANGELINE PAVLAKOS RPH

Provider Business Mailing Address
First Line	:	2620 CARLISLE BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-2802
Country	:	US
Telephone Number	:	505-884-0455
Fax Number	:	505-872-1642

Provider Business Practice Location Address
First Line	:	2620 CARLISLE BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-2802
Country	:	US
Telephone Number	:	505-884-0455
Fax Number	:	505-872-1642

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

Provider Enumeration Date	:	09/17/2010
Last Update Date	:	09/17/2010

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Directions to “ EVANGELINE PAVLAKOS RPH” Practice Location

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