Provider Demographics
NPI:1104110550
Name:ACEVEDO-ZAMOT, DOBRYNA
Entity type:Individual
Prefix:
First Name:DOBRYNA
Middle Name:
Last Name:ACEVEDO-ZAMOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CAMPO RICO & EL COMANDANTE AVE
Mailing Address - Street 2:WALGREENS 2803
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982
Mailing Address - Country:US
Mailing Address - Phone:787-776-2003
Mailing Address - Fax:
Practice Address - Street 1:AVE CAMPO RICO & EL COMANDANTE
Practice Address - Street 2:WALGREENS DRUGSTORE 2803
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-0000
Practice Address - Country:US
Practice Address - Phone:787-776-2003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4510183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4510OtherPHARMACY LICENSE NUMBER