Healthcare Provider Details

I. General information

NPI: 1184868853
Provider Name (Legal Business Name): MARLA ESTEVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2009
Last Update Date: 04/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 TONGASS DR
SITKA AK
99835-9416
US

IV. Provider business mailing address

1321 SAWMILL CREEK RD APT. K2
SITKA AK
99835-9740
US

V. Phone/Fax

Practice location:
  • Phone: 907-966-9782
  • Fax:
Mailing address:
  • Phone: 210-355-0106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number37628
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: