Provider Demographics
NPI:1649641630
Name:MUNOZ ALCIVAR, LEONOR MARILIN (PHARMD)
Entity type:Individual
Prefix:
First Name:LEONOR
Middle Name:MARILIN
Last Name:MUNOZ ALCIVAR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6208 QUEBEC ST
Mailing Address - Street 2:
Mailing Address - City:BERWYN HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20740-2740
Mailing Address - Country:US
Mailing Address - Phone:802-343-6551
Mailing Address - Fax:
Practice Address - Street 1:7041 MARTIN LUTHER KING JR HWY
Practice Address - Street 2:KING SHOPPING CENTER
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-4016
Practice Address - Country:US
Practice Address - Phone:301-386-6141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23622183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist