Provider Demographics
NPI:1801118922
Name:LETDIN PHARMACY
Entity type:Organization
Organization Name:LETDIN PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:LAETITIA
Authorized Official - Middle Name:ANDIN
Authorized Official - Last Name:FOMBON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-837-9976
Mailing Address - Street 1:1512 E GRIFFIN PARKWAY
Mailing Address - Street 2:STE 1
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2422
Mailing Address - Country:US
Mailing Address - Phone:956-581-9566
Mailing Address - Fax:956-581-9568
Practice Address - Street 1:1512 E GRIFFIN PARKWAY
Practice Address - Street 2:STE 1
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2422
Practice Address - Country:US
Practice Address - Phone:956-581-9566
Practice Address - Fax:956-581-9568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-16
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX268003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146124Medicaid