Healthcare Provider Details

I. General information

NPI: 1760175285
Provider Name (Legal Business Name): GILBERT C LEU RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E HIGHWAY 12 STE D
VALLEY SPRINGS CA
95252-9494
US

IV. Provider business mailing address

368 EDGEBROOK DR
IONE CA
95640-9510
US

V. Phone/Fax

Practice location:
  • Phone: 209-772-9681
  • Fax:
Mailing address:
  • Phone: 209-601-0337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRPH040206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: