Healthcare Provider Details

I. General information

NPI: 1609146125
Provider Name (Legal Business Name): ILEANA LEONOR SOSA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2012
Last Update Date: 01/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 STATE RD
CINCINNATI OH
45255-2439
US

IV. Provider business mailing address

7500 STATE RD
CINCINNATI OH
45255-2439
US

V. Phone/Fax

Practice location:
  • Phone: 513-624-4668
  • Fax: 513-624-4820
Mailing address:
  • Phone: 513-624-4668
  • Fax: 513-624-4820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03117697
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: