Provider Demographics
NPI:1164755799
Name:LETERSKY, BRIAN CRAIG
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:CRAIG
Last Name:LETERSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7036 WERTZVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-1542
Mailing Address - Country:US
Mailing Address - Phone:717-697-3450
Mailing Address - Fax:
Practice Address - Street 1:7036 WERTZVILLE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-1542
Practice Address - Country:US
Practice Address - Phone:717-697-3450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP045633L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist