Provider Demographics
NPI:1720338650
Name:LEROY, PATRICK NELSON (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:NELSON
Last Name:LEROY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2110 TRUXTUN AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3703
Mailing Address - Country:US
Mailing Address - Phone:661-716-2673
Mailing Address - Fax:661-716-2677
Practice Address - Street 1:1017 ELLINGTON ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-2621
Practice Address - Country:US
Practice Address - Phone:661-725-9489
Practice Address - Fax:661-725-3640
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA58396OtherCALIFORNIA STATE BOARD OF PHARMACY