Provider Demographics
NPI:1528619863
Name:ANTYPAS, EVELINA (PHARMD)
Entity type:Individual
Prefix:
First Name:EVELINA
Middle Name:
Last Name:ANTYPAS
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 1:2109 HUGHES DR STE 550
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-5103
Mailing Address - Country:US
Mailing Address - Phone:419-291-2010
Mailing Address - Fax:419-480-8715
Practice Address - Street 1:2109 HUGHES DR STE 550
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-5103
Practice Address - Country:US
Practice Address - Phone:419-291-2010
Practice Address - Fax:419-480-8715
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411969183500000X
OH03338001183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist