Healthcare Provider Details

I. General information

NPI: 1801416391
Provider Name (Legal Business Name): JESSIE ESCALANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 FM 517 RD W STE 606A
DICKINSON TX
77539-3904
US

IV. Provider business mailing address

614 FM 517 RD W STE 606A
DICKINSON TX
77539-3904
US

V. Phone/Fax

Practice location:
  • Phone: 281-836-5920
  • Fax: 281-836-5921
Mailing address:
  • Phone: 281-836-5920
  • Fax: 281-836-5921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number31689
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: