Provider Demographics
NPI:1346517885
Name:ANBALAGAN, GOWRI
Entity type:Individual
Prefix:MRS
First Name:GOWRI
Middle Name:
Last Name:ANBALAGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-2927
Mailing Address - Country:US
Mailing Address - Phone:407-287-6735
Mailing Address - Fax:407-287-6740
Practice Address - Street 1:2130 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-2927
Practice Address - Country:US
Practice Address - Phone:407-287-6735
Practice Address - Fax:407-287-6740
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39398183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist