Healthcare Provider Details

I. General information

NPI: 1659972008
Provider Name (Legal Business Name): DAVID ESCAMILLA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

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

5000 W NATIONAL AVE
MILWAUKEE WI
53295-0001
US

IV. Provider business mailing address

13235 W BURLEIGH RD APT 6
BROOKFIELD WI
53005-3050
US

V. Phone/Fax

Practice location:
  • Phone: 414-384-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20428
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: