Provider Demographics
NPI:1497554414
Name:DESHAZO, KEVIN RAY (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:RAY
Last Name:DESHAZO
Suffix:
Gender:
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4508 MINE RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-2616
Mailing Address - Country:US
Mailing Address - Phone:540-845-5525
Mailing Address - Fax:
Practice Address - Street 1:4508 MINE RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-2616
Practice Address - Country:US
Practice Address - Phone:540-845-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230022201183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician