MEDICARE: MR. ARLEN LEIS 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	052429	NY

General Provider Information

NPI Number	:	1306169230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ARLEN LEIS PHARMD

Provider Business Mailing Address
First Line	:	2925 W 5TH ST
Second Line	:	APT 14H
City	:	BROOKLYN
State	:	NY
Zip	:	11224-3962
Country	:	US
Telephone Number	:	917-693-6826
Fax Number	:

Provider Business Practice Location Address
First Line	:	499 NEPTUNE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4003
Country	:	US
Telephone Number	:	718-449-5177
Fax Number	:

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

Provider Enumeration Date	:	03/06/2010
Last Update Date	:	03/06/2010

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