Provider Demographics
NPI:1982204962
Name:SALAZAR, LEANTHONY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LEANTHONY
Middle Name:
Last Name:SALAZAR
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 1:5626 WALZEM RD
Mailing Address - Street 2:
Mailing Address - City:WINDCREST
Mailing Address - State:TX
Mailing Address - Zip Code:78218-2105
Mailing Address - Country:US
Mailing Address - Phone:210-507-0652
Mailing Address - Fax:210-507-0653
Practice Address - Street 1:5626 WALZEM RD
Practice Address - Street 2:
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78218-2105
Practice Address - Country:US
Practice Address - Phone:210-507-0652
Practice Address - Fax:210-507-0653
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist