Provider Demographics
NPI:1073916086
Name:RODRIGUEZ ACOSTA, SERGIO (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:RODRIGUEZ ACOSTA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9951 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1805
Mailing Address - Country:US
Mailing Address - Phone:305-207-2334
Mailing Address - Fax:
Practice Address - Street 1:9951 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1805
Practice Address - Country:US
Practice Address - Phone:305-207-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-04
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist