Provider Demographics
NPI:1740521293
Name:ESTEVIS, RAMON RENE
Entity type:Individual
Prefix:
First Name:RAMON
Middle Name:RENE
Last Name:ESTEVIS
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 1:65 E SCOTT ST APT 14P
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-5278
Mailing Address - Country:US
Mailing Address - Phone:312-502-0145
Mailing Address - Fax:
Practice Address - Street 1:65 E SCOTT ST APT 14P
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-5278
Practice Address - Country:US
Practice Address - Phone:312-502-0145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40641183500000X
IL293212183500000X
OR0011695183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist