Provider Demographics
NPI:1912501503
Name:ARCHIE, ESTELLA
Entity Type:Individual
Prefix:
First Name:ESTELLA
Middle Name:
Last Name:ARCHIE
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 1:8955 US HIGHWAY 301 N # 231
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-8701
Mailing Address - Country:US
Mailing Address - Phone:954-551-1981
Mailing Address - Fax:
Practice Address - Street 1:301 S 6TH AVE
Practice Address - Street 2:
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873-3206
Practice Address - Country:US
Practice Address - Phone:863-767-1195
Practice Address - Fax:863-767-1960
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS495911835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist