Provider Demographics
NPI:1598041808
Name:ABALLE, LEONARDO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:
Last Name:ABALLE
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 1:18590 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6818
Mailing Address - Country:US
Mailing Address - Phone:305-238-4901
Mailing Address - Fax:
Practice Address - Street 1:18590 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6818
Practice Address - Country:US
Practice Address - Phone:305-238-4901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42986183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104734500Medicaid