Provider Demographics
NPI:1699926675
Name:VAN ZYL, ALETTA CECELIA
Entity type:Individual
Prefix:MRS
First Name:ALETTA
Middle Name:CECELIA
Last Name:VAN ZYL
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 1:1743 ALEXANDRIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3112
Mailing Address - Country:US
Mailing Address - Phone:859-278-3471
Mailing Address - Fax:
Practice Address - Street 1:1743 ALEXANDRIA DRIVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3112
Practice Address - Country:US
Practice Address - Phone:859-278-3471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY013582OtherKENTUCKY PHARMACY BOARD