Provider Demographics
NPI:1497025100
Name:FELICIANO-ACEVEDO, XAVIER OMAR (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:XAVIER
Middle Name:OMAR
Last Name:FELICIANO-ACEVEDO
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:PO BOX 3252
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-3252
Mailing Address - Country:US
Mailing Address - Phone:787-672-9422
Mailing Address - Fax:
Practice Address - Street 1:URB VILLA LINDA #52 CALLE TURPIAL
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-672-9422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist