Healthcare Provider Details

I. General information

NPI: 1528157179
Provider Name (Legal Business Name): LEITERS CAMBRIAN PARK DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 PARK AVE STE 30
SAN JOSE CA
95126-2033
US

IV. Provider business mailing address

1700 PARK AVE STE 30
SAN JOSE CA
95126-2033
US

V. Phone/Fax

Practice location:
  • Phone: 408-292-6772
  • Fax: 408-288-8252
Mailing address:
  • Phone: 408-292-6772
  • Fax: 408-288-8252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY45940
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHUCK LEITER
Title or Position: PRESIDENT
Credential:
Phone: 408-292-6772