Provider Demographics
NPI:1487654208
Name:BLANCO-CEPED, EDWIN FERNANDO (CPHT)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:FERNANDO
Last Name:BLANCO-CEPED
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9207 CENTRO BONITO
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-1294
Mailing Address - Country:US
Mailing Address - Phone:210-678-9710
Mailing Address - Fax:
Practice Address - Street 1:7979 WURZBACH RD, STE G354
Practice Address - Street 2:INVESTIGATIONAL DRUG SECTION
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-616-5885
Practice Address - Fax:210-616-5589
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113781183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician