Provider Demographics
NPI:1740889104
Name:DELA CRUZ, MARCO ANTONIO ESTERA (PHARM D)
Entity type:Individual
Prefix:DR
First Name:MARCO ANTONIO
Middle Name:ESTERA
Last Name:DELA CRUZ
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 S GEORGE MASON DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1676
Mailing Address - Country:US
Mailing Address - Phone:571-403-9357
Mailing Address - Fax:
Practice Address - Street 1:950 S GEORGE MASON DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1676
Practice Address - Country:US
Practice Address - Phone:571-403-9357
Practice Address - Fax:703-705-7560
Is Sole Proprietor?:No
Enumeration Date:2020-10-18
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH100003835183500000X
VA0202217101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist