Provider Demographics
NPI:1992309975
Name:ACOSTA, DIEGO (PHARM D)
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5880 BOULDER FALLS ST APT 2026
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-4933
Mailing Address - Country:US
Mailing Address - Phone:702-812-2366
Mailing Address - Fax:
Practice Address - Street 1:4391 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5715
Practice Address - Country:US
Practice Address - Phone:702-452-2937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20689183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist