Provider Demographics
NPI:1851676753
Name:ESTANISLAO, DEBORAH KAY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:KAY
Last Name:ESTANISLAO
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 1:13255 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-3127
Mailing Address - Country:US
Mailing Address - Phone:904-220-6606
Mailing Address - Fax:904-220-0633
Practice Address - Street 1:13255 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-3127
Practice Address - Country:US
Practice Address - Phone:904-220-6606
Practice Address - Fax:904-220-0633
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0033929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104010300Medicaid