Provider Demographics
NPI:1790831626
Name:ACEVEDO, LUIS ALBERTO
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ALBERTO
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 1:8 CALLE 1A
Mailing Address - Street 2:ALTURAS DE BERWIND
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-2465
Mailing Address - Country:US
Mailing Address - Phone:787-257-0757
Mailing Address - Fax:
Practice Address - Street 1:50 CALLE BRAZIL STE 2
Practice Address - Street 2:GARDENVILLE
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-2037
Practice Address - Country:US
Practice Address - Phone:787-782-1180
Practice Address - Fax:787-782-2765
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist