Provider Demographics
NPI:1922673193
Name:TOVAR CERDA, FERNANDO (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:TOVAR CERDA
Suffix:
Gender:M
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-3423
Mailing Address - Country:US
Mailing Address - Phone:310-639-8026
Mailing Address - Fax:310-639-9314
Practice Address - Street 1:107 S LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3423
Practice Address - Country:US
Practice Address - Phone:310-639-8026
Practice Address - Fax:310-639-9314
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA146068183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician