Basic Information
| Provider Information | |||||||||
| NPI: | 1619202199 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LETSKY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | CURTIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2717 RHODE ISLAND ST NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871103701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052724261 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6605 4TH ST NW | ||||||||
| Address2: | |||||||||
| City: | LOS RANCHOS DE ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871076112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053459059 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2009 | ||||||||
| LastUpdateDate: | 10/16/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RP00007192 | NM | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.