Provider Demographics
NPI:1497972103
Name:KECK, LEON JASON (RPH)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:JASON
Last Name:KECK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:L
Other - Middle Name:JASON
Other - Last Name:KECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:648 MATTHEW WAY
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-1433
Mailing Address - Country:US
Mailing Address - Phone:805-474-4960
Mailing Address - Fax:
Practice Address - Street 1:1132 W BRANCH ST
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-1906
Practice Address - Country:US
Practice Address - Phone:805-474-4909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH43833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist