Provider Demographics
NPI:1003250747
Name:LEITER'S ENTERPRISES, INC. DBA LEITER'S COMPOUNDING PHARMACY
Entity Type:Organization
Organization Name:LEITER'S ENTERPRISES, INC. DBA LEITER'S COMPOUNDING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WOLFE
Authorized Official - Last Name:LEITER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:408-292-6772
Mailing Address - Street 1:1700 PARK AVE STE 30
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2034
Mailing Address - Country:US
Mailing Address - Phone:408-292-6772
Mailing Address - Fax:408-288-8252
Practice Address - Street 1:17 GREAT OAKS BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1359
Practice Address - Country:US
Practice Address - Phone:408-292-6772
Practice Address - Fax:408-288-8252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy