Provider Demographics
NPI:1639277510
Name:ESTRADA, JANE E (PHARMACIST)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:E
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:EDGERTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:5788 ECKHERT RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3900
Mailing Address - Country:US
Mailing Address - Phone:210-699-2289
Mailing Address - Fax:210-699-2208
Practice Address - Street 1:5788 ECKHERT RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3900
Practice Address - Country:US
Practice Address - Phone:210-699-2289
Practice Address - Fax:210-699-2208
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist