Provider Demographics
NPI:1619358728
Name:BLAUSTEIN, ESTELA (RPH, FAARM)
Entity Type:Individual
Prefix:
First Name:ESTELA
Middle Name:
Last Name:BLAUSTEIN
Suffix:
Gender:F
Credentials:RPH, FAARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 PROMENADE BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2777
Mailing Address - Country:US
Mailing Address - Phone:201-543-3640
Mailing Address - Fax:201-781-5686
Practice Address - Street 1:3110 PROMENADE BLVD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2777
Practice Address - Country:US
Practice Address - Phone:201-543-3640
Practice Address - Fax:201-781-5686
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI025350001835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy