Provider Demographics
NPI:1013281625
Name:DAVILA, JACQUELINE LEA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:LEA
Last Name:DAVILA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 HOLLYHOCK RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-2522
Mailing Address - Country:US
Mailing Address - Phone:210-601-2923
Mailing Address - Fax:210-242-6268
Practice Address - Street 1:1423 GUADALUPE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5527
Practice Address - Country:US
Practice Address - Phone:210-226-5293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist