Provider Demographics
NPI:1750009890
Name:LEVENTIN, VICTORIA MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARIE
Last Name:LEVENTIN
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 1:3108 W SUMMIT WALK CT
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-1014
Mailing Address - Country:US
Mailing Address - Phone:602-578-7024
Mailing Address - Fax:
Practice Address - Street 1:14100 N 83RD AVE STE 160
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5653
Practice Address - Country:US
Practice Address - Phone:623-230-9194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS025935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist