Provider Demographics
NPI:1417437377
Name:ESTRADA, MEGHAN LEIGH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:LEIGH
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 CANONGATE WAY
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908-9380
Mailing Address - Country:US
Mailing Address - Phone:479-650-8320
Mailing Address - Fax:
Practice Address - Street 1:3009 CANONGATE WAY
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72908-9380
Practice Address - Country:US
Practice Address - Phone:479-650-8320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD16012183500000X
NMRP000056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist