Provider Demographics
NPI:1700171550
Name:ESPINOZA, MARY G (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:G
Last Name:ESPINOZA
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 1:239 BLANCO DR
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-5204
Mailing Address - Country:US
Mailing Address - Phone:830-387-0955
Mailing Address - Fax:
Practice Address - Street 1:239 BLANCO DR
Practice Address - Street 2:
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-5204
Practice Address - Country:US
Practice Address - Phone:830-387-0955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25287183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist