Provider Demographics
NPI:1730463779
Name:PELOZA, DOREEN LEE (RPH)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:LEE
Last Name:PELOZA
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 1:128 ROCHE WAY
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6220
Mailing Address - Country:US
Mailing Address - Phone:330-726-5960
Mailing Address - Fax:
Practice Address - Street 1:7295 MARKET ST.
Practice Address - Street 2:WALGREENS
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512
Practice Address - Country:US
Practice Address - Phone:330-726-9374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-19362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist