Provider Demographics
NPI:1972156099
Name:DEDIOS, DEBRALIZ EAY (PHARMD)
Entity type:Individual
Prefix:
First Name:DEBRALIZ
Middle Name:EAY
Last Name:DEDIOS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DEBRALIZ
Other - Middle Name:ECLARINO
Other - Last Name:ECLEVIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7545 FOXRIDGE WAY APT 418
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-3708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:595 E PARKS HWY
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8150
Practice Address - Country:US
Practice Address - Phone:907-352-1160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK146510183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist