Provider Demographics
NPI:1124327432
Name:ACEVEDO LOPEZ, BEDZAIDA (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:MRS
First Name:BEDZAIDA
Middle Name:
Last Name:ACEVEDO LOPEZ
Suffix:
Gender:F
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:HC 1 BOX 6543
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-9506
Mailing Address - Country:US
Mailing Address - Phone:787-360-0845
Mailing Address - Fax:
Practice Address - Street 1:CALLE JOSE MENEDEZ CARDONA #3
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-896-1850
Practice Address - Fax:787-896-8025
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6266183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician