Provider Demographics
NPI:1679725493
Name:ACOSTA, RAFAEL (RPH)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3836 INDIGO RUN DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1128
Mailing Address - Country:US
Mailing Address - Phone:804-307-4033
Mailing Address - Fax:
Practice Address - Street 1:40 W 225TH ST # 50
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-7016
Practice Address - Country:US
Practice Address - Phone:718-733-6927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist