Provider Demographics
NPI:1144836248
Name:ALBA, ESTELA MORALES (RPH)
Entity type:Individual
Prefix:
First Name:ESTELA
Middle Name:MORALES
Last Name:ALBA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 SEAMAN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76111-4919
Mailing Address - Country:US
Mailing Address - Phone:817-885-9338
Mailing Address - Fax:
Practice Address - Street 1:8600 HARRY HINES BLVD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-3005
Practice Address - Country:US
Practice Address - Phone:888-282-4801
Practice Address - Fax:844-343-3504
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist