Provider Demographics
NPI:1861095382
Name:ACOSTA, ANGEL JR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:
Last Name:ACOSTA
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 E LYNN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-5456
Mailing Address - Country:US
Mailing Address - Phone:682-226-3759
Mailing Address - Fax:
Practice Address - Street 1:2323 W ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-1637
Practice Address - Country:US
Practice Address - Phone:214-331-5466
Practice Address - Fax:214-467-4417
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57857183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist