Provider Demographics
NPI:1194876110
Name:VELAZQUEZ, EDWIN A (RPH)
Entity type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:A
Last Name:VELAZQUEZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STREET 129
Mailing Address - Street 2:SUITE D-303
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-209-8127
Mailing Address - Fax:787-879-5058
Practice Address - Street 1:STREET #2 KM. 84.2
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-209-8127
Practice Address - Fax:787-879-5058
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist