Provider Demographics
NPI:1669871752
Name:ORJUELA, ANTONIETTE ARCEBIDO (RPH, PHARM D)
Entity type:Individual
Prefix:DR
First Name:ANTONIETTE
Middle Name:ARCEBIDO
Last Name:ORJUELA
Suffix:
Gender:F
Credentials:RPH, PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 WAVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-2403
Mailing Address - Country:US
Mailing Address - Phone:718-522-1706
Mailing Address - Fax:
Practice Address - Street 1:69 WAVERLY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-2403
Practice Address - Country:US
Practice Address - Phone:718-522-1706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039114-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist