Healthcare Provider Details

I. General information

NPI: 1871878116
Provider Name (Legal Business Name): LEO SKRZYPEK RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 HOLLYWOOD BLVD
HOLLYWOOD FL
33021-6810
US

IV. Provider business mailing address

3705 HOLLYWOOD BLVD
HOLLYWOOD FL
33021-6810
US

V. Phone/Fax

Practice location:
  • Phone: 954-962-4787
  • Fax: 954-962-8446
Mailing address:
  • Phone: 954-962-4787
  • Fax: 954-962-8446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS21886
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0005308
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: