Provider Demographics
NPI:1417044926
Name:IRIZARRY-ACOSTA, JAVIER (RPH)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:IRIZARRY-ACOSTA
Suffix:
Gender:M
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:PO BOX 21506
Mailing Address - Street 2:UNIVERSITY STATION
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00931-1506
Mailing Address - Country:US
Mailing Address - Phone:787-763-1228
Mailing Address - Fax:
Practice Address - Street 1:PLAZA ENCANTADA
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-6301
Practice Address - Country:US
Practice Address - Phone:787-763-1228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist