MEDICARE: MRS. EVELYN ETOH

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	PS40835	FL

General Provider Information

NPI Number	:	1437431699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EVELYN ETOH

Provider Business Mailing Address
First Line	:	356 STREAMVIEW WAY
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-6407
Country	:	US
Telephone Number	:	407-312-3254
Fax Number	:

Provider Business Practice Location Address
First Line	:	356 STREAMVIEW WAY
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-6407
Country	:	US
Telephone Number	:	407-312-3254
Fax Number	:

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

Provider Enumeration Date	:	09/14/2011
Last Update Date	:	09/14/2011

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