Provider Demographics
NPI:1336667096
Name:LAI, LEON QUOC (PHARMD)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:QUOC
Last Name:LAI
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 1:13300 N 88TH AVE APT 3140
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-3849
Mailing Address - Country:US
Mailing Address - Phone:714-837-3096
Mailing Address - Fax:
Practice Address - Street 1:13723 LITCHFIELD RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379
Practice Address - Country:US
Practice Address - Phone:623-255-3208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS022853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist