Provider Demographics
NPI:1437210911
Name:ESPIMAR CORPORATION
Entity Type:Organization
Organization Name:ESPIMAR CORPORATION
Other - Org Name:MARQUEZ PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-558-8002
Mailing Address - Street 1:5901 W 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6813
Mailing Address - Country:US
Mailing Address - Phone:305-558-8002
Mailing Address - Fax:305-826-3165
Practice Address - Street 1:5901 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6813
Practice Address - Country:US
Practice Address - Phone:305-558-8002
Practice Address - Fax:305-826-3165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH64333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103116300Medicaid
FL103116300Medicaid