Healthcare Provider Details

I. General information

NPI: 1699408690
Provider Name (Legal Business Name): EMMANUEL ESPINOSA PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 NW 41ST ST
DORAL FL
33178-1867
US

IV. Provider business mailing address

401 SW 109TH AVE APT 4
MIAMI FL
33174-1373
US

V. Phone/Fax

Practice location:
  • Phone: 305-477-0184
  • Fax:
Mailing address:
  • Phone: 786-365-7635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS64211
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: