Provider Demographics
NPI:1760175285
Name:LEU, GILBERT C (RPH)
Entity Type:Individual
Prefix:MR
First Name:GILBERT
Middle Name:C
Last Name:LEU
Suffix:
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 1:368 EDGEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:IONE
Mailing Address - State:CA
Mailing Address - Zip Code:95640-9510
Mailing Address - Country:US
Mailing Address - Phone:209-601-0337
Mailing Address - Fax:
Practice Address - Street 1:200 E HIGHWAY 12 STE D
Practice Address - Street 2:
Practice Address - City:VALLEY SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95252-9494
Practice Address - Country:US
Practice Address - Phone:209-772-9681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH0402061835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care