Provider Demographics
NPI:1629368063
Name:LEANDRO, ANDRE
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:LEANDRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 LACKAWANNA ST
Mailing Address - Street 2:APT 9-2
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-1551
Mailing Address - Country:US
Mailing Address - Phone:610-790-7084
Mailing Address - Fax:
Practice Address - Street 1:2769 PAPERMILL RD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3329
Practice Address - Country:US
Practice Address - Phone:610-374-9942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444287183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist