Provider Demographics
NPI:1215224308
Name:LEONG, LIDIA CHANG (PHARM D)
Entity Type:Individual
Prefix:
First Name:LIDIA
Middle Name:CHANG
Last Name:LEONG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10451 FAIRWAY DR
Mailing Address - Street 2:T-1502
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-1987
Mailing Address - Country:US
Mailing Address - Phone:916-780-2898
Mailing Address - Fax:916-780-2898
Practice Address - Street 1:10451 FAIRWAY DR
Practice Address - Street 2:T-1502
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-1987
Practice Address - Country:US
Practice Address - Phone:916-780-2898
Practice Address - Fax:916-780-2898
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH58747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist