Provider Demographics
NPI:1427481779
Name:ESPARRA, EDWIN (RPH)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:ESPARRA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BUTTERNUT LN
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-7942
Mailing Address - Country:US
Mailing Address - Phone:717-766-0934
Mailing Address - Fax:717-458-3446
Practice Address - Street 1:1110 ENTERPRISE RD
Practice Address - Street 2:
Practice Address - City:E PETERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17520-1604
Practice Address - Country:US
Practice Address - Phone:717-925-2380
Practice Address - Fax:717-925-2399
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP033534L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist