Provider Demographics
NPI:1417736406
Name:ESTRADA, TANIA LESLIE (RPH)
Entity Type:Individual
Prefix:DR
First Name:TANIA
Middle Name:LESLIE
Last Name:ESTRADA
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 1:3649 MEADOW BRIDGE RD # 2
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1356
Mailing Address - Country:US
Mailing Address - Phone:410-713-8338
Mailing Address - Fax:
Practice Address - Street 1:28516 DUPONT BLVD
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-4739
Practice Address - Country:US
Practice Address - Phone:302-934-3190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0015966183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist