Provider Demographics
NPI:1407384381
Name:ULLRICH, LEROY K (RPH)
Entity Type:Individual
Prefix:MR
First Name:LEROY
Middle Name:K
Last Name:ULLRICH
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 1:1500 DISTRICT AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-5069
Mailing Address - Country:US
Mailing Address - Phone:781-229-7345
Mailing Address - Fax:855-829-6228
Practice Address - Street 1:1500 DISTRICT AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-5069
Practice Address - Country:US
Practice Address - Phone:781-229-7345
Practice Address - Fax:855-829-6228
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH18967333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy