Provider Demographics
NPI:1982676755
Name:LUIS A ACEVEDO
Entity Type:Organization
Organization Name:LUIS A ACEVEDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-782-1180
Mailing Address - Street 1:BRASIL 50 SUITE 2
Mailing Address - Street 2:GARDENVILLE
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-782-1180
Mailing Address - Fax:787-782-2765
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PR19F14123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2082973OtherPK