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General NPI Number Information
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NPI Number | 1801118922
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Entity Type | Organization
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Legal Business Name | LETDIN PHARMACY
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Dates
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Enumeration Date | 02/16/2010
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Last Update Date | 03/24/2015
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Provider Practice Location Address
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Address Line | 1512 E GRIFFIN PARKWAY STE 1
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City | MISSION
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State | TX
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Zip | 78572-2422
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Country | US
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Telephone | 956-581-9566
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Fax | 956-581-9568
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Provider Business Mailing Address
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Address Line | 1512 E GRIFFIN PARKWAY STE 1
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City | MISSION
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State | TX
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Zip | 78572-2422
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Country | US
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Telephone | 956-581-9566
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Fax | 956-581-9568
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | DR. LAETITIA ANDIN FOMBON
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Credential |
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Telephone | 214-837-9976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 26800
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License Number State | TX
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