Provider Demographics
NPI:1700162310
Name:LEO, MING (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:MING
Middle Name:
Last Name:LEO
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 1:14028 PASEO CEVERA
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2710
Mailing Address - Country:US
Mailing Address - Phone:614-286-3266
Mailing Address - Fax:
Practice Address - Street 1:14028 PASEO CEVERA
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2710
Practice Address - Country:US
Practice Address - Phone:614-286-3266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist