Provider Demographics
NPI:1740619477
Name:LEEDS, CLIFFORD (BS PHARMACY)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:
Last Name:LEEDS
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 SE FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-4909
Mailing Address - Country:US
Mailing Address - Phone:772-288-6541
Mailing Address - Fax:772-288-6543
Practice Address - Street 1:4001 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-4909
Practice Address - Country:US
Practice Address - Phone:772-288-6541
Practice Address - Fax:772-288-6543
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS25884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist