Healthcare Provider Details

I. General information

NPI: 1538161799
Provider Name (Legal Business Name): FREDERICK LERI PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 QUINCY AVE
SCRANTON PA
18510-1724
US

IV. Provider business mailing address

29 GREYSTONE DR
MOUNTAIN TOP PA
18707-1282
US

V. Phone/Fax

Practice location:
  • Phone: 570-340-2270
  • Fax: 570-340-2017
Mailing address:
  • Phone: 570-474-0635
  • Fax: 570-474-0649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP034395T
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: