Provider Demographics
NPI:1104959386
Name:LESTICO, MITCHELL ROBERT (PHARMD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:ROBERT
Last Name:LESTICO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3328 RANCH PARK TRL
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2341
Mailing Address - Country:US
Mailing Address - Phone:512-255-2936
Mailing Address - Fax:
Practice Address - Street 1:15822 FOOTHILL FARMS LOOP
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3422
Practice Address - Country:US
Practice Address - Phone:512-251-6096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX342491835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy