Provider Demographics
NPI:1457664575
Name:MA, LELAND K (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:LELAND
Middle Name:K
Last Name:MA
Suffix:
Gender:M
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 1:17215 HORST AVE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2733
Mailing Address - Country:US
Mailing Address - Phone:562-562-4175
Mailing Address - Fax:323-235-3513
Practice Address - Street 1:4322 S FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-2642
Practice Address - Country:US
Practice Address - Phone:323-235-3535
Practice Address - Fax:232-235-3513
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-18
Last Update Date:2010-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32234183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist