Provider Demographics
NPI:1962002089
Name:LEONG, VASCO (PHARM D)
Entity Type:Individual
Prefix:
First Name:VASCO
Middle Name:
Last Name:LEONG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 KADY LN
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1471
Mailing Address - Country:US
Mailing Address - Phone:732-266-2381
Mailing Address - Fax:
Practice Address - Street 1:18 KADY LN
Practice Address - Street 2:
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-1471
Practice Address - Country:US
Practice Address - Phone:732-266-2381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03077300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist