MEDICARE: ELVIE REYES DELEON PHARMD

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	28956	CA

General Provider Information

NPI Number	:	1114439049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELVIE REYES DELEON PHARMD

Provider Business Mailing Address
First Line	:	18402 PAMMY LN
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-1436
Country	:	US
Telephone Number	:	714-841-5118
Fax Number	:	714-375-4333

Provider Business Practice Location Address
First Line	:	7191 WARNER AVE
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-5429
Country	:	US
Telephone Number	:	714-841-5118
Fax Number	:	714-375-4333

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

Provider Enumeration Date	:	11/01/2017
Last Update Date	:	11/01/2017

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