Provider Demographics
NPI:1740655620
Name:LEONOV, DMITRY (PHRAMD)
Entity type:Individual
Prefix:DR
First Name:DMITRY
Middle Name:
Last Name:LEONOV
Suffix:
Gender:M
Credentials:PHRAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 GRANDE VISTA DR STE 725
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-1131
Mailing Address - Country:US
Mailing Address - Phone:747-777-0023
Mailing Address - Fax:
Practice Address - Street 1:4601 DALE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9718
Practice Address - Country:US
Practice Address - Phone:209-735-5000
Practice Address - Fax:209-825-2405
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV181081835P0018X
CA636531835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist