Provider Demographics
NPI:1699408690
Name:ESPINOSA, EMMANUEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:
Last Name:ESPINOSA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 SW 109TH AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1373
Mailing Address - Country:US
Mailing Address - Phone:786-365-7635
Mailing Address - Fax:
Practice Address - Street 1:10701 NW 41ST ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-1867
Practice Address - Country:US
Practice Address - Phone:305-477-0184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS64211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist