Provider Demographics
NPI:1033710421
Name:TORRES, LEONARDO ROBERTO (RPH)
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:ROBERTO
Last Name:TORRES
Suffix:
Gender:M
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:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-0002
Mailing Address - Country:US
Mailing Address - Phone:214-478-2679
Mailing Address - Fax:
Practice Address - Street 1:2662 W LUCAS RD
Practice Address - Street 2:
Practice Address - City:LUCAS
Practice Address - State:TX
Practice Address - Zip Code:75002-7513
Practice Address - Country:US
Practice Address - Phone:469-675-8110
Practice Address - Fax:469-675-8528
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist