Healthcare Provider Details

I. General information

NPI: 1851832133
Provider Name (Legal Business Name): DALE LEINWEBER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 JACKSON ST
RICHMOND TX
77469-3248
US

IV. Provider business mailing address

1600 JACKSON ST
RICHMOND TX
77469-3248
US

V. Phone/Fax

Practice location:
  • Phone: 361-879-5976
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number130207
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: