Provider Demographics
NPI:1124395157
Name:LEDESMA, ENRIQUE JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:
Last Name:LEDESMA
Suffix:JR
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 1:708 E EXPRESSWAY 83
Mailing Address - Street 2:T-0824
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1609
Mailing Address - Country:US
Mailing Address - Phone:956-686-4068
Mailing Address - Fax:956-278-8731
Practice Address - Street 1:708 E EXPRESSWAY 83
Practice Address - Street 2:T-0824
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1609
Practice Address - Country:US
Practice Address - Phone:956-686-4068
Practice Address - Fax:956-278-8731
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist