Healthcare Provider Details

I. General information

NPI: 1366042384
Provider Name (Legal Business Name): ROSA LAURA ESCAMILLA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 SW MILITARY DR
SAN ANTONIO TX
78224-1038
US

IV. Provider business mailing address

4906 SUNSET GLADE
SAN ANTONIO TX
78240-5437
US

V. Phone/Fax

Practice location:
  • Phone: 210-932-0906
  • Fax:
Mailing address:
  • Phone: 210-854-3911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number67115
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: