Provider Demographics
NPI:1760783310
Name:ACEVEDO, MARTA (RPH)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARTA
Other - Middle Name:
Other - Last Name:ACEVEDO-TOLEDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:3650 S GLEBE RD
Mailing Address - Street 2:UNIT 342
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-2395
Mailing Address - Country:US
Mailing Address - Phone:703-521-1983
Mailing Address - Fax:
Practice Address - Street 1:3650 S GLEBE RD
Practice Address - Street 2:UNIT 342
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-2395
Practice Address - Country:US
Practice Address - Phone:703-521-1983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-14
Last Update Date:2010-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210230183500000X
PR4429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist