Provider Demographics
NPI:1760801906
Name:DE LEON, JOSE (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:
Last Name:DE LEON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:J.
Other - Middle Name:DAVID
Other - Last Name:DE LEON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:5413 N 136TH AVE
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-8346
Mailing Address - Country:US
Mailing Address - Phone:602-758-8823
Mailing Address - Fax:
Practice Address - Street 1:10707 W CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-5073
Practice Address - Country:US
Practice Address - Phone:623-872-5316
Practice Address - Fax:623-872-9696
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist