Individual
CHIVAS OWLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4930 E LAKE MARY BLVD, SANFORD, FL 32771-5003
(407) 322-8653
Mailing address
4930 E LAKE MARY BLVD, SANFORD, FL 32771-5003
(407) 322-8653
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PS50371
FL
Other
Enumeration date
06/14/2023
Last updated
06/14/2023
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