Provider Demographics
NPI:1407874639
Name:LEAL, RICARDO J (R,PH)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:J
Last Name:LEAL
Suffix:
Gender:M
Credentials:R,PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 SW MILITARY DR STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1580
Mailing Address - Country:US
Mailing Address - Phone:210-922-1816
Mailing Address - Fax:210-922-9732
Practice Address - Street 1:919 SW MILITARY DR STE 105
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1580
Practice Address - Country:US
Practice Address - Phone:210-922-1816
Practice Address - Fax:210-922-9732
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20479183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20479OtherPHARMACIST LICENSE