Provider Demographics
NPI:1861746026
Name:DAVELIS, EFTHEMIA (PHARMD)
Entity type:Individual
Prefix:
First Name:EFTHEMIA
Middle Name:
Last Name:DAVELIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:
Other - Last Name:DAVELIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3960 LINDELL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-3204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3960 LINDELL BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-3204
Practice Address - Country:US
Practice Address - Phone:314-533-2992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012025395183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist