Provider Demographics
NPI:1275751232
Name:ACEVEDO-RENTAS, GLORIA A (RPH)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:A
Last Name:ACEVEDO-RENTAS
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 1:13822 EAGLES GLEN CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-8032
Mailing Address - Country:US
Mailing Address - Phone:407-856-1341
Mailing Address - Fax:
Practice Address - Street 1:1347 E VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-3602
Practice Address - Country:US
Practice Address - Phone:407-933-8856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist