Healthcare Provider Details

I. General information

NPI: 1619291911
Provider Name (Legal Business Name): SANDRA ESPINOSA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2634 WEST ST APT 2A
BROOKLYN NY
11223-6433
US

IV. Provider business mailing address

2634 WEST ST APT 2A
BROOKLYN NY
11223-6433
US

V. Phone/Fax

Practice location:
  • Phone: 718-646-2668
  • Fax:
Mailing address:
  • Phone: 718-646-2668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number030471
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: