Provider Demographics
NPI:1861969446
Name:SPINO, EMILIE ROSE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:EMILIE
Middle Name:ROSE
Last Name:SPINO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 ELLEN CIR
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2631
Mailing Address - Country:US
Mailing Address - Phone:718-864-8245
Mailing Address - Fax:
Practice Address - Street 1:500 TOMPKINS AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-1798
Practice Address - Country:US
Practice Address - Phone:718-727-0426
Practice Address - Fax:718-816-1803
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist