Provider Demographics
NPI:1609267145
Name:ESTAFANOS, RAMIZ
Entity Type:Individual
Prefix:
First Name:RAMIZ
Middle Name:
Last Name:ESTAFANOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8491 FORT SMALLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-2739
Mailing Address - Country:US
Mailing Address - Phone:410-255-5361
Mailing Address - Fax:410-255-9178
Practice Address - Street 1:8491 FORT SMALLWOOD RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2739
Practice Address - Country:US
Practice Address - Phone:410-255-5361
Practice Address - Fax:410-255-9178
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23039183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist