Healthcare Provider Details

I. General information

NPI: 1730914086
Provider Name (Legal Business Name): JAFET ESCOBAR PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 W SUNSET RD APT 239
HENDERSON NV
89014-6636
US

IV. Provider business mailing address

3850 MOUNTAIN VISTA ST APT 239
LAS VEGAS NV
89121-4669
US

V. Phone/Fax

Practice location:
  • Phone: 747-474-3659
  • Fax:
Mailing address:
  • Phone: 747-474-3659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24309
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: