Provider Demographics
NPI:1336352434
Name:LEO, TERESINA ENRICHETTA (RPH)
Entity Type:Individual
Prefix:MISS
First Name:TERESINA
Middle Name:ENRICHETTA
Last Name:LEO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3728 SW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315-3078
Mailing Address - Country:US
Mailing Address - Phone:515-243-4612
Mailing Address - Fax:
Practice Address - Street 1:4343 MERLE HAY RD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-1411
Practice Address - Country:US
Practice Address - Phone:515-276-4845
Practice Address - Fax:515-331-3163
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist