Provider Demographics
NPI:1609219047
Name:NEDEDOG DE PEREZ, ROSALIE C (RPH)
Entity Type:Individual
Prefix:
First Name:ROSALIE
Middle Name:C
Last Name:NEDEDOG DE PEREZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2721
Mailing Address - Country:US
Mailing Address - Phone:970-669-6275
Mailing Address - Fax:970-679-4683
Practice Address - Street 1:253 E 29TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2721
Practice Address - Country:US
Practice Address - Phone:970-669-6275
Practice Address - Fax:970-679-4683
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15556183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist