Provider Demographics
NPI:1629259007
Name:DE LEON, LUIS RICARDO (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:RICARDO
Last Name:DE LEON
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 1:2121 HEPBURN ST APT 502
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-3218
Mailing Address - Country:US
Mailing Address - Phone:832-262-9397
Mailing Address - Fax:
Practice Address - Street 1:2121 HEPBURN ST
Practice Address - Street 2:UNIT 502
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-3242
Practice Address - Country:US
Practice Address - Phone:832-262-9397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
TX47108183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist