Provider Demographics
NPI:1215420492
Name:EAPEN, OLIVIA LAINE (PHARMD)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:LAINE
Last Name:EAPEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 VILLAGE BLVD APT 903
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-2847
Mailing Address - Country:US
Mailing Address - Phone:616-550-9951
Mailing Address - Fax:
Practice Address - Street 1:831 VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-1901
Practice Address - Country:US
Practice Address - Phone:561-615-6808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist