Provider Demographics
NPI:1952063901
Name:ESHAK, DINA W
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:W
Last Name:ESHAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 SENECA DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-6574
Mailing Address - Country:US
Mailing Address - Phone:760-300-9608
Mailing Address - Fax:
Practice Address - Street 1:498 BUSHY HILL RD
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-2931
Practice Address - Country:US
Practice Address - Phone:860-651-9843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0015621183500000X
TX70474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist