Provider Demographics
NPI:1437584471
Name:ACEVEDO, RENE J (PHARMD)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:J
Last Name:ACEVEDO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4124 LAKE UNDERHILL RD APT 108
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-7086
Mailing Address - Country:US
Mailing Address - Phone:407-340-6979
Mailing Address - Fax:
Practice Address - Street 1:550 TECHNOLOGY PARK
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-7131
Practice Address - Country:US
Practice Address - Phone:888-315-3395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL33862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist