Provider Demographics
NPI:1700101946
Name:ESTREMS, FERNANDO IGNACIO (RPH)
Entity Type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:IGNACIO
Last Name:ESTREMS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 60TH ST
Mailing Address - Street 2:PAN AMERICAN PHARMACY
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-2824
Mailing Address - Country:US
Mailing Address - Phone:201-861-7966
Mailing Address - Fax:201-868-7945
Practice Address - Street 1:232 60TH ST
Practice Address - Street 2:PAN AMERICAN PHARMACY
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-2824
Practice Address - Country:US
Practice Address - Phone:201-861-7966
Practice Address - Fax:201-868-7945
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02224500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI02224500OtherSTATE LICENSE