Healthcare Provider Details

I. General information

NPI: 1912227976
Provider Name (Legal Business Name): LEONARD SERY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6363 FRANKFORD AVE
PHILADELPHIA PA
19135
US

IV. Provider business mailing address

300 BYBERRY RD, APT #216
PHILADELPHIA PA
19116-1944
US

V. Phone/Fax

Practice location:
  • Phone: 215-335-4882
  • Fax: 215-335-2067
Mailing address:
  • Phone: 215-464-1365
  • Fax: 215-335-2067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP044798Y
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: