Provider Demographics
NPI:1467780775
Name:CORONADO, LETICIA GUADALUPE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LETICIA
Middle Name:GUADALUPE
Last Name:CORONADO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 REVEILLE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-5526
Mailing Address - Country:US
Mailing Address - Phone:713-644-1848
Mailing Address - Fax:713-644-8930
Practice Address - Street 1:3900 REVEILLE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-5526
Practice Address - Country:US
Practice Address - Phone:713-644-1848
Practice Address - Fax:713-644-8930
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35955183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist