Provider Demographics
NPI:1245749944
Name:ESPINOSA, MICHELLE MORALES (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MORALES
Last Name:ESPINOSA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10939 BROOKFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-4243
Mailing Address - Country:US
Mailing Address - Phone:209-751-6566
Mailing Address - Fax:
Practice Address - Street 1:1449 E F ST STE 102
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-9266
Practice Address - Country:US
Practice Address - Phone:209-847-4279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77405183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist