Healthcare Provider Details

I. General information

NPI: 1629938758
Provider Name (Legal Business Name): ILIANA ESCAMILLA CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9595 SIX PINES DR
THE WOODLANDS TX
77380-1531
US

IV. Provider business mailing address

9595 SIX PINES DR
THE WOODLANDS TX
77380-1531
US

V. Phone/Fax

Practice location:
  • Phone: 281-292-3962
  • Fax:
Mailing address:
  • Phone: 281-292-3962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number284441
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: