Provider Demographics
NPI:1265035455
Name:LEMUS PEDRAZA, BALTAZAR (PHARMD)
Entity Type:Individual
Prefix:
First Name:BALTAZAR
Middle Name:
Last Name:LEMUS PEDRAZA
Suffix:
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 1:2001 S THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-6329
Mailing Address - Country:US
Mailing Address - Phone:479-927-1568
Mailing Address - Fax:
Practice Address - Street 1:2001 S THOMPSON ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-6329
Practice Address - Country:US
Practice Address - Phone:479-927-1568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist