MEDICARE: MS. MICHELLE M LEU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	43029	CA

General Provider Information

NPI Number	:	1073865432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE M LEU

Provider Business Mailing Address
First Line	:	1650 DECOTO RD
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-3544
Country	:	US
Telephone Number	:	510-429-0195
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 DECOTO RD
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-3544
Country	:	US
Telephone Number	:	510-429-0195
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2012
Last Update Date	:	10/10/2012

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