Healthcare Provider Details

I. General information

NPI: 1982205258
Provider Name (Legal Business Name): AUGUSTINE ESCAMILLA JR. PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6703 W LOOP 1604 N
SAN ANTONIO TX
78254-9539
US

IV. Provider business mailing address

6310 GERANIUM
SAN ANTONIO TX
78253-5863
US

V. Phone/Fax

Practice location:
  • Phone: 210-688-3890
  • Fax: 210-688-3873
Mailing address:
  • Phone: 210-623-0414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number52013
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: