Provider Demographics
NPI:1114518107
Name:ACOSTA REYES, SHARLENE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHARLENE
Middle Name:
Last Name:ACOSTA REYES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 NW 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2421
Mailing Address - Country:US
Mailing Address - Phone:787-342-5638
Mailing Address - Fax:
Practice Address - Street 1:3750 NW 87TH AVE UNIT B
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4670
Practice Address - Country:US
Practice Address - Phone:786-331-8203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6871183500000X
FLPS62018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist