Provider Demographics
NPI:1619307253
Name:LEONG, WILSON (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:WILSON
Middle Name:
Last Name:LEONG
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 1:4809 MCDONELL AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-3005
Mailing Address - Country:US
Mailing Address - Phone:510-482-1049
Mailing Address - Fax:510-482-8630
Practice Address - Street 1:4809 MCDONELL AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-3005
Practice Address - Country:US
Practice Address - Phone:510-482-1049
Practice Address - Fax:510-482-8630
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist