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General NPI Number Information
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NPI Number | 1215013529
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Entity Type | Individual
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Provider Name | LEONARD STANLEY BLOOM RPH
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Gender | Male
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Dates
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Enumeration Date | 10/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12120 MOON LAKE RD
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City | NEW PORT RICHEY
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State | FL
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Zip | 34654-1809
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Country | US
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Telephone | 727-856-3588
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Fax | 727-856-2705
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Provider Business Mailing Address
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Address Line | 6439 GENTLE BEN CIR
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City | ZEPHYRHILLS
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State | FL
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Zip | 33544-3448
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Country | US
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Telephone | 813-991-7178
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Fax | 813-991-7566
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS13195
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License Number State | FL
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