Provider Demographics
NPI:1679564165
Name:LEETZ, DONALD ROBERT JR (RPH)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:ROBERT
Last Name:LEETZ
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 921
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53052-0921
Mailing Address - Country:US
Mailing Address - Phone:262-257-3070
Mailing Address - Fax:262-250-7008
Practice Address - Street 1:W180N8085 TOWN HALL RD
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-3518
Practice Address - Country:US
Practice Address - Phone:262-257-3070
Practice Address - Fax:262-250-7008
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist