Provider Demographics
NPI:1013290287
Name:BEZMEN, ALICIA KIRAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:KIRAN
Last Name:BEZMEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:KIRAN
Other - Last Name:FORTENBERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1350 N WICKHAM RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8945
Mailing Address - Country:US
Mailing Address - Phone:321-254-5507
Mailing Address - Fax:
Practice Address - Street 1:1350 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8945
Practice Address - Country:US
Practice Address - Phone:321-254-5507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist