Healthcare Provider Details

I. General information

NPI: 1841334257
Provider Name (Legal Business Name): JOEL THOMAS LEU R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 SHATTUCK AVE
BERKELEY CA
94709-1611
US

IV. Provider business mailing address

321 DUNCAN ST # A
SAN FRANCISCO CA
94131-2021
US

V. Phone/Fax

Practice location:
  • Phone: 510-549-9201
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number51435
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12317
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: