Provider Demographics
NPI:1992309249
Name:LEIFUR, RHONDA (RPH)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:LEIFUR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 CULEBRA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-5813
Mailing Address - Country:US
Mailing Address - Phone:210-785-9764
Mailing Address - Fax:210-785-9488
Practice Address - Street 1:2018 CULEBRA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-5813
Practice Address - Country:US
Practice Address - Phone:210-785-9764
Practice Address - Fax:210-785-9488
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX465838Medicaid