Provider Demographics
NPI:1275848905
Name:PASTRANA, ESTELLA S (RPH)
Entity Type:Individual
Prefix:
First Name:ESTELLA
Middle Name:S
Last Name:PASTRANA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2913 ARCTIC AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-3706
Mailing Address - Country:US
Mailing Address - Phone:646-251-9572
Mailing Address - Fax:
Practice Address - Street 1:1332 WEST AVE
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:NJ
Practice Address - Zip Code:08226-3268
Practice Address - Country:US
Practice Address - Phone:609-814-1954
Practice Address - Fax:609-814-0720
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03163800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist