Healthcare Provider Details

I. General information

NPI: 1457664575
Provider Name (Legal Business Name): LELAND K MA PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2010
Last Update Date: 07/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4322 S FIGUEROA ST
LOS ANGELES CA
90037-2642
US

IV. Provider business mailing address

17215 HORST AVE
CERRITOS CA
90703-2733
US

V. Phone/Fax

Practice location:
  • Phone: 323-235-3535
  • Fax: 232-235-3513
Mailing address:
  • Phone: 562-562-4175
  • Fax: 323-235-3513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number32234
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: