MEDICARE: DR. JACQUELINE ESQUEDA PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	53236	TX

General Provider Information

NPI Number	:	1063807659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE ESQUEDA PHARMD

Provider Business Mailing Address
First Line	:	110 STONE OAK LOOP STE 100
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3510
Country	:	US
Telephone Number	:	210-598-2678
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 STONE OAK LOOP STE 100
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3510
Country	:	US
Telephone Number	:	210-598-2678
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2015
Last Update Date	:	04/01/2015

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