Provider Demographics
NPI:1982720850
Name:VIDETSKY, REBECCA L (PHARMD,RPH)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:L
Last Name:VIDETSKY
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 1:14 BRANDYWINE DR
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-1148
Mailing Address - Country:US
Mailing Address - Phone:215-646-2673
Mailing Address - Fax:
Practice Address - Street 1:14 BRANDYWINE DR
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-1148
Practice Address - Country:US
Practice Address - Phone:215-646-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13439-040183500000X
PARP438215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist