Provider Demographics
NPI:1770125148
Name:LEGISLADOR, JOEN REDD N
Entity type:Individual
Prefix:
First Name:JOEN REDD
Middle Name:N
Last Name:LEGISLADOR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 CHALAN SAN ANTONIO
Mailing Address - Street 2:PHOTO TOWN PLAZA SUITE 100
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3392
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:353 CHALAN SAN ANTONIO STE 100
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3300
Practice Address - Country:US
Practice Address - Phone:671-649-1977
Practice Address - Fax:671-646-5338
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPH0311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist