Provider Demographics
NPI:1639449457
Name:ACELAS, ORISSEAU (PHARMD)
Entity Type:Individual
Prefix:
First Name:ORISSEAU
Middle Name:
Last Name:ACELAS
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 1:15241 SONOMA DR APT 201
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-7698
Mailing Address - Country:US
Mailing Address - Phone:786-663-9222
Mailing Address - Fax:
Practice Address - Street 1:15241 SONOMA DR APT 201
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-7698
Practice Address - Country:US
Practice Address - Phone:786-663-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist