Provider Demographics
NPI:1215013529
Name:BLOOM, LEONARD STANLEY (RPH)
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:STANLEY
Last Name:BLOOM
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 1:6439 GENTLE BEN CIR
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33544-3448
Mailing Address - Country:US
Mailing Address - Phone:813-991-7178
Mailing Address - Fax:813-991-7566
Practice Address - Street 1:12120 MOON LAKE RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-1809
Practice Address - Country:US
Practice Address - Phone:727-856-3588
Practice Address - Fax:727-856-2705
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS13195183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist