Healthcare Provider Details

I. General information

NPI: 1578119228
Provider Name (Legal Business Name): KENNETH ALLEN LEAL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MURRAY AVE
PITTSBURGH PA
15217-1604
US

IV. Provider business mailing address

1166 MARBLE DR
CRESCENT PA
15046-5002
US

V. Phone/Fax

Practice location:
  • Phone: 412-521-3900
  • Fax:
Mailing address:
  • Phone: 412-477-8190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP452968
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPI012709
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: