Healthcare Provider Details

I. General information

NPI: 1336329705
Provider Name (Legal Business Name): RAQUEL M ESPOSITO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 BAY PKWY
BROOKLYN NY
11204-2566
US

IV. Provider business mailing address

5901 BAY PKWY
BROOKLYN NY
11204-2566
US

V. Phone/Fax

Practice location:
  • Phone: 718-236-6161
  • Fax:
Mailing address:
  • Phone: 718-236-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number050566
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: