Healthcare Provider Details

I. General information

NPI: 1225523459
Provider Name (Legal Business Name): MARTA ESPELOSIN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2961 W 12TH AVE
HIALEAH FL
33012-4833
US

IV. Provider business mailing address

2961 W 12TH AVE
HIALEAH FL
33012-4833
US

V. Phone/Fax

Practice location:
  • Phone: 305-888-2224
  • Fax:
Mailing address:
  • Phone: 305-888-2224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS37311
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: