Provider Demographics
NPI:1710576228
Name:LEEPER, NICHOLAS ANDREW (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLAS
Middle Name:ANDREW
Last Name:LEEPER
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:ANDREW
Other - Last Name:LEEPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10718 POTRANCO RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-3312
Mailing Address - Country:US
Mailing Address - Phone:210-681-2301
Mailing Address - Fax:210-681-5736
Practice Address - Street 1:10718 POTRANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3312
Practice Address - Country:US
Practice Address - Phone:210-681-2301
Practice Address - Fax:210-681-5736
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX242472183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician