Provider Demographics
NPI:1467238485
Name:QUEVEDO, ANGEL ANDY
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:ANDY
Last Name:QUEVEDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 W HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-6053
Mailing Address - Country:US
Mailing Address - Phone:813-871-0481
Mailing Address - Fax:813-877-7195
Practice Address - Street 1:2724 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-6053
Practice Address - Country:US
Practice Address - Phone:813-872-0481
Practice Address - Fax:813-877-7195
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS66301183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist