Provider Demographics
NPI:1053865600
Name:LEANDRO, RANDY MARTIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:MARTIN
Last Name:LEANDRO
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 1:738 GURTEN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2604
Mailing Address - Country:US
Mailing Address - Phone:508-558-2141
Mailing Address - Fax:
Practice Address - Street 1:2004 S GLENBURNIE RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5227
Practice Address - Country:US
Practice Address - Phone:252-634-1716
Practice Address - Fax:252-772-4338
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26240183500000X
SC36584183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist