Healthcare Provider Details

I. General information

NPI: 1932980323
Provider Name (Legal Business Name): ERICA ESPINO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8628 S COTTAGE GROVE AVE
CHICAGO IL
60619-6108
US

IV. Provider business mailing address

8628 S COTTAGE GROVE AVE
CHICAGO IL
60619-6108
US

V. Phone/Fax

Practice location:
  • Phone: 269-277-9685
  • Fax:
Mailing address:
  • Phone: 269-277-9685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number015305892
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: