Provider Demographics
NPI:1619202199
Name:LETSKY, MICHAEL CURTIS
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CURTIS
Last Name:LETSKY
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 1:2717 RHODE ISLAND ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3701
Mailing Address - Country:US
Mailing Address - Phone:505-272-4261
Mailing Address - Fax:
Practice Address - Street 1:6605 4TH ST NW
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS DE ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-6112
Practice Address - Country:US
Practice Address - Phone:505-345-9059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist