MEDICARE: EVANGELINE CARLOS PHARMD

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	77938	CA

General Provider Information

NPI Number	:	1528992401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVANGELINE CARLOS PHARMD

Provider Business Mailing Address
First Line	:	2193 TRINWAY AVE
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-2747
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6345 BALBOA BLVD
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-1519
Country	:	US
Telephone Number	:	818-798-3833
Fax Number	:

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

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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Directions to “ EVANGELINE CARLOS PHARMD” Practice Location

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