Provider Demographics
NPI:1235444324
Name:CORSON, JOHANNA L (RPH)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:L
Last Name:CORSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:KATHLEEN
Other - Last Name:LESHIKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:3325 W WADLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-5714
Mailing Address - Country:US
Mailing Address - Phone:432-697-1484
Mailing Address - Fax:432-699-2645
Practice Address - Street 1:3325 W WADLEY AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-5714
Practice Address - Country:US
Practice Address - Phone:432-697-1484
Practice Address - Fax:432-699-2645
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29697183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist