Provider Demographics
NPI:1427332600
Name:PEDRAYES-VALDES, LISSETTE (RPH)
Entity type:Individual
Prefix:MRS
First Name:LISSETTE
Middle Name:
Last Name:PEDRAYES-VALDES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12807 US HIGHWAY 301
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525
Mailing Address - Country:US
Mailing Address - Phone:352-567-9606
Mailing Address - Fax:
Practice Address - Street 1:12807 US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525
Practice Address - Country:US
Practice Address - Phone:352-567-9606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist