Provider Demographics
NPI:1982071932
Name:LEFTRIDGE, DON JUAN
Entity Type:Individual
Prefix:
First Name:DON JUAN
Middle Name:
Last Name:LEFTRIDGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 WOOSTER DR
Mailing Address - Street 2:
Mailing Address - City:BRYANS ROAD
Mailing Address - State:MD
Mailing Address - Zip Code:20616-3021
Mailing Address - Country:US
Mailing Address - Phone:202-322-1170
Mailing Address - Fax:
Practice Address - Street 1:52 CENTRAL AVE W
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2622
Practice Address - Country:US
Practice Address - Phone:410-919-1160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23461183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist