Healthcare Provider Details

I. General information

NPI: 1972103208
Provider Name (Legal Business Name): BROOKE ASHLY ESQUIVEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 22ND ST
HONDO TX
78861-2514
US

IV. Provider business mailing address

435 BLUE RIDGE DR
SAN ANTONIO TX
78228-6303
US

V. Phone/Fax

Practice location:
  • Phone: 830-426-3305
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number67318
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: