Provider Demographics
NPI:1174907067
Name:ESPINOZA, MILTON J
Entity type:Individual
Prefix:
First Name:MILTON
Middle Name:J
Last Name:ESPINOZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6155 98TH ST
Mailing Address - Street 2:APT. 6E
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1434
Mailing Address - Country:US
Mailing Address - Phone:917-886-7203
Mailing Address - Fax:
Practice Address - Street 1:6155 98TH ST
Practice Address - Street 2:APT. 6E
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1434
Practice Address - Country:US
Practice Address - Phone:917-886-7203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028067183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist