Provider Demographics
NPI:1548679913
Name:ELLADO, ESTELA
Entity type:Individual
Prefix:
First Name:ESTELA
Middle Name:
Last Name:ELLADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45660 TRAFALGAR DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-5428
Mailing Address - Country:US
Mailing Address - Phone:661-802-6941
Mailing Address - Fax:
Practice Address - Street 1:37140 47TH ST E
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-4450
Practice Address - Country:US
Practice Address - Phone:661-533-1029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-10
Last Update Date:2014-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist