Healthcare Provider Details

I. General information

NPI: 1104534270
Provider Name (Legal Business Name): HARRIEL ACOSTA MEDINA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 11/08/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 INFANTRY & JESUS FRAGOSO
CAROLINA PR
00983
US

IV. Provider business mailing address

PMB 254 PO BOX 2500
TOA BAJA PR
00951
US

V. Phone/Fax

Practice location:
  • Phone: 787-769-4122
  • Fax:
Mailing address:
  • Phone: 787-219-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2413
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: