Provider Demographics
NPI:1578098174
Name:ACEVEDO, REY
Entity Type:Individual
Prefix:
First Name:REY
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR 464 KM 3.0 INT
Mailing Address - Street 2:BO ACEITUNAS
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0598
Mailing Address - Country:US
Mailing Address - Phone:787-546-5966
Mailing Address - Fax:787-877-5923
Practice Address - Street 1:HC 3 BOX 9017
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-0598
Practice Address - Country:US
Practice Address - Phone:787-546-5966
Practice Address - Fax:787-877-5923
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7725183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician