1114144896 NPI number — JORGE LUIS ACEVEDO PHARMACIST

Table of content: JORGE LUIS ACEVEDO PHARMACIST (NPI 1114144896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114144896 NPI number — JORGE LUIS ACEVEDO PHARMACIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ACEVEDO
Provider First Name:
JORGE
Provider Middle Name:
LUIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMACIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114144896
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 543
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARES
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00669-0543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-897-4159
Provider Business Mailing Address Fax Number:
787-897-3945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA 129
Provider Second Line Business Practice Location Address:
KM 21.8 BO.CALLEJONES
Provider Business Practice Location Address City Name:
LARES
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-897-3945
Provider Business Practice Location Address Fax Number:
787-897-3945
Provider Enumeration Date:
04/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  3363 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3363 . This is a "PHARMACIST LICENCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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