Healthcare Provider Details

I. General information

NPI: 1235545872
Provider Name (Legal Business Name): SANN LEANG RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 W LEHIGH AVE
PHILADELPHIA PA
19133-3425
US

IV. Provider business mailing address

260 W LEHIGH AVE
PHILADELPHIA PA
19133-3425
US

V. Phone/Fax

Practice location:
  • Phone: 215-425-3784
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP440885
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: