Provider Demographics
NPI:1922524164
Name:DE LEON, NOEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:
Last Name:DE LEON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 15TH ST APT 1D
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3515
Mailing Address - Country:US
Mailing Address - Phone:305-240-1183
Mailing Address - Fax:
Practice Address - Street 1:730 15 STREET APT 1-D
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139
Practice Address - Country:US
Practice Address - Phone:305-240-1183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45938183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD450782630OtherDRIVERS LICENSE