Provider Demographics
NPI:1710562954
Name:CASTRO, LEIRA VICTORIA
Entity Type:Individual
Prefix:
First Name:LEIRA
Middle Name:VICTORIA
Last Name:CASTRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3503 SE 2ND DR
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7507
Mailing Address - Country:US
Mailing Address - Phone:786-525-3950
Mailing Address - Fax:
Practice Address - Street 1:33501 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-5628
Practice Address - Country:US
Practice Address - Phone:305-242-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS62059183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist