Healthcare Provider Details

I. General information

NPI: 1952451098
Provider Name (Legal Business Name): EDNA VELAZQUEZ RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST
BRONX NY
10451-5504
US

IV. Provider business mailing address

PO BOX 750802
FOREST HILLS NY
11375-0802
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5959
  • Fax:
Mailing address:
  • Phone: 718-261-5554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number036548-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: