Provider Demographics
NPI:1467767954
Name:LECLAIR, DEREK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:
Last Name:LECLAIR
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 1:1237 S SANDSTONE ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4363
Mailing Address - Country:US
Mailing Address - Phone:480-720-7984
Mailing Address - Fax:
Practice Address - Street 1:1237 S SANDSTONE ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4363
Practice Address - Country:US
Practice Address - Phone:480-720-7984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSO17481183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist