Provider Demographics
NPI:1467732180
Name:ACOSTA, RICARDO A (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:A
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 FAYETTEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-2230
Mailing Address - Country:US
Mailing Address - Phone:479-474-8859
Mailing Address - Fax:479-474-8740
Practice Address - Street 1:1601 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-2230
Practice Address - Country:US
Practice Address - Phone:479-474-8859
Practice Address - Fax:479-474-8740
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD09313183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist