=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245749944
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE MORALES ESPINOSA PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2017
-----------------------------------------------------
Last Update Date | 09/25/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1449 E F ST STE 102
-----------------------------------------------------
City | OAKDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95361-9266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-847-4279
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10939 BROOKFIELD AVE
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95209-4243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-751-6566
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 77405
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------