Provider Demographics
NPI:1053816660
Name:LEUNG, THEODORE (PHARMD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:
Last Name:LEUNG
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 1:1234 MILITARY W
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-2430
Mailing Address - Country:US
Mailing Address - Phone:510-228-7840
Mailing Address - Fax:
Practice Address - Street 1:1234 MILITARY W
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-2430
Practice Address - Country:US
Practice Address - Phone:510-228-7840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist