Provider Demographics
NPI:1003010885
Name:CEDENO, CESAR ENRIQUE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CESAR
Middle Name:ENRIQUE
Last Name:CEDENO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 SW PEACOCK BLVD
Mailing Address - Street 2:#203
Mailing Address - City:SAINT LUCIE WEST
Mailing Address - State:FL
Mailing Address - Zip Code:34986-4500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1705 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5544
Practice Address - Country:US
Practice Address - Phone:772-569-1414
Practice Address - Fax:772-568-5181
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS40214OtherFLORIDA PHARMACY LICENSE