Provider Demographics
NPI:1154737039
Name:ZAMUDIO-MARTINEZ, LESLIE G (PHARMD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:G
Last Name:ZAMUDIO-MARTINEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5755 PINON BLANCO RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4861
Mailing Address - Country:US
Mailing Address - Phone:575-302-8097
Mailing Address - Fax:
Practice Address - Street 1:8011 HARPER DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1054
Practice Address - Country:US
Practice Address - Phone:505-858-3134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00008181183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist