Provider Demographics
NPI:1043920432
Name:DELATORRE, MANUEL LEETS I (RPH)
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:LEETS
Last Name:DELATORRE
Suffix:I
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 1:11246 S WILCREST DR STE 180
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-4386
Mailing Address - Country:US
Mailing Address - Phone:281-272-6723
Mailing Address - Fax:281-760-1631
Practice Address - Street 1:11246 S WILCREST DR STE 180
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-4386
Practice Address - Country:US
Practice Address - Phone:281-272-6723
Practice Address - Fax:281-760-1631
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist