Provider Demographics
NPI:1982720207
Name:PETER LEON INC
Entity Type:Organization
Organization Name:PETER LEON INC
Other - Org Name:TESMAN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-747-8917
Mailing Address - Street 1:257 N 52ND ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-1502
Mailing Address - Country:US
Mailing Address - Phone:215-747-8917
Mailing Address - Fax:215-747-8918
Practice Address - Street 1:257 N 52ND ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-1502
Practice Address - Country:US
Practice Address - Phone:215-747-8917
Practice Address - Fax:215-747-8918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP412540L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3912070OtherNCPDP PROVIDER IDENTIFICATION NUMBER
PA0005699320001Medicaid