Provider Demographics
NPI:1275223133
Name:ESTRADA, JOSHUA (RPH)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9113 SHADY RUN
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-5567
Mailing Address - Country:US
Mailing Address - Phone:210-718-4018
Mailing Address - Fax:
Practice Address - Street 1:8602 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1805
Practice Address - Country:US
Practice Address - Phone:210-691-0174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist