Provider Demographics
NPI:1831540814
Name:LEONG, EDWIN (PHARMD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:LEONG
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 1:623 MCALLISTER DR
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3992
Mailing Address - Country:US
Mailing Address - Phone:707-334-5878
Mailing Address - Fax:
Practice Address - Street 1:623 MCALLISTER DR
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3992
Practice Address - Country:US
Practice Address - Phone:707-334-5878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist