Provider Demographics
NPI:1487909354
Name:ACOSTA, ELIZABETH (RPH)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ACOSTA
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 1:1554 LOPEZ LANDRON STREET
Mailing Address - Street 2:APT 408
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911
Mailing Address - Country:US
Mailing Address - Phone:787-764-1194
Mailing Address - Fax:787-756-8807
Practice Address - Street 1:370 AVE DOMENECH
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3720
Practice Address - Country:US
Practice Address - Phone:787-764-1194
Practice Address - Fax:787-756-8807
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist