Provider Demographics
NPI:1669072484
Name:ROSAS ACEVEDO, EDNALIZ
Entity type:Individual
Prefix:
First Name:EDNALIZ
Middle Name:
Last Name:ROSAS ACEVEDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1842 PARKVIEW BLVD APT 202
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-5203
Mailing Address - Country:US
Mailing Address - Phone:787-515-0201
Mailing Address - Fax:
Practice Address - Street 1:1700 MURRAY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-1604
Practice Address - Country:US
Practice Address - Phone:412-521-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP454973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist