Provider Demographics
NPI:1972312304
Name:ESPINOZA, GENARO JR (PHARMD)
Entity type:Individual
Prefix:
First Name:GENARO
Middle Name:JR
Last Name:ESPINOZA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 NE 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1524
Mailing Address - Country:US
Mailing Address - Phone:971-358-6888
Mailing Address - Fax:
Practice Address - Street 1:1619 NE 42ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1524
Practice Address - Country:US
Practice Address - Phone:971-358-6888
Practice Address - Fax:971-358-6889
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0020137183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist