Provider Demographics
NPI:1952683070
Name:LEU, NINA M (PHARMD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:M
Last Name:LEU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 E YORBA LINDA BLVD
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3830
Mailing Address - Country:US
Mailing Address - Phone:714-579-7451
Mailing Address - Fax:714-579-7563
Practice Address - Street 1:1201 E YORBA LINDA BLVD
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3830
Practice Address - Country:US
Practice Address - Phone:714-579-7451
Practice Address - Fax:714-579-7563
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH54907183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist