Provider Demographics
NPI:1760821722
Name:ACOSTA, JESUS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:
Last Name:ACOSTA
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 1:4935 SW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1345
Mailing Address - Country:US
Mailing Address - Phone:786-302-2515
Mailing Address - Fax:
Practice Address - Street 1:4935 SW 6TH ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1345
Practice Address - Country:US
Practice Address - Phone:786-302-2515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-22
Last Update Date:2013-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist