Provider Demographics
NPI:1912274135
Name:ACOSTA, PATRICIA PERERA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:PERERA
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15195 SW 42ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-3949
Mailing Address - Country:US
Mailing Address - Phone:305-223-7895
Mailing Address - Fax:305-223-7996
Practice Address - Street 1:15195 SW 42ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-3949
Practice Address - Country:US
Practice Address - Phone:305-223-7895
Practice Address - Fax:305-223-7996
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0028751183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist