Provider Demographics
NPI:1578919510
Name:LEITERS ENTERPRISES INC
Entity Type:Organization
Organization Name:LEITERS ENTERPRISES INC
Other - Org Name:LEI COMPOUNDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:408-292-6772
Mailing Address - Street 1:6541 VIA DEL ORO STE B
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1207
Mailing Address - Country:US
Mailing Address - Phone:408-326-1530
Mailing Address - Fax:408-824-1368
Practice Address - Street 1:6541 VIA DEL ORO STE B
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1207
Practice Address - Country:US
Practice Address - Phone:408-326-1530
Practice Address - Fax:408-824-1368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY546523336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159846OtherPK