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General NPI Number Information
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NPI Number | 1154603025
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Entity Type | Individual
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Provider Name | LESHIA RENE MARTINO
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Gender | Female
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Dates
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Enumeration Date | 09/15/2011
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Last Update Date | 09/15/2011
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Provider Practice Location Address
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Address Line | 1700 WEST RD
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City | TRENTON
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State | MI
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Zip | 48183-2676
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Country | US
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Telephone | 734-675-2997
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Fax | 734-675-6695
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Provider Business Mailing Address
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Address Line | 15035 WILLIAMSBURG ST
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City | RIVERVIEW
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State | MI
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Zip | 48193-7703
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Country | US
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Telephone | 734-285-2415
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302410542
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License Number State | MI
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