Provider Demographics
NPI:1659656080
Name:ACEVEDO, SONJA (RPH)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:
Last Name:ACEVEDO
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 1:207 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292-6330
Mailing Address - Country:US
Mailing Address - Phone:318-361-7390
Mailing Address - Fax:
Practice Address - Street 1:207 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-6330
Practice Address - Country:US
Practice Address - Phone:318-361-7390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist