Healthcare Provider Details

I. General information

NPI: 1780549030
Provider Name (Legal Business Name): MRS. ROSALIE BAIN ACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROSALIE ACOSTA

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12515 SW 88TH ST
MIAMI FL
33186-1829
US

IV. Provider business mailing address

9000 SW 64TH CT
PINECREST FL
33156-1825
US

V. Phone/Fax

Practice location:
  • Phone: 305-631-3892
  • Fax: 305-631-3893
Mailing address:
  • Phone: 305-631-3892
  • Fax: 305-631-3893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0023011
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: