Healthcare Provider Details

I. General information

NPI: 1043518129
Provider Name (Legal Business Name): ALDA PETRA BERNARDEZ RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2011
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3539 PATTERSON AVENUE
WINSTON SALEM NC
27105
US

IV. Provider business mailing address

1016 BRANNIGAN VILLAGE DR
WINSTON SALEM NC
27127-4886
US

V. Phone/Fax

Practice location:
  • Phone: 336-767-0232
  • Fax:
Mailing address:
  • Phone: 336-245-9656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20054
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: