Provider Demographics
NPI:1881938553
Name:LEUNG, DEREK (RPH)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:
Last Name:LEUNG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 BRENTWOOD ESTATES CT
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-4902
Mailing Address - Country:US
Mailing Address - Phone:678-777-1877
Mailing Address - Fax:770-205-8002
Practice Address - Street 1:2750 BRENTWOOD ESTATES CT
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-4902
Practice Address - Country:US
Practice Address - Phone:678-777-1877
Practice Address - Fax:770-205-8002
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18729183500000X
FLPS29183183500000X
VA0202009405183500000X
GA016408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist