Provider Demographics
NPI:1982156428
Name:AZEVEDO, VANESSA C (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:C
Last Name:AZEVEDO
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2029
Mailing Address - Country:US
Mailing Address - Phone:908-418-8046
Mailing Address - Fax:
Practice Address - Street 1:35 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2029
Practice Address - Country:US
Practice Address - Phone:908-418-8046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03568200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist