MEDICARE: LEITERS ENTERPRISES INC

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	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy	PHY54652	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2159846	OTHER		PK

General Provider Information

NPI Number	:	1578919510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEITERS ENTERPRISES INC

Provider Business Mailing Address
First Line	:	6541 VIA DEL ORO STE B
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95119-1207
Country	:	US
Telephone Number	:	408-326-1530
Fax Number	:	408-824-1368

Provider Business Practice Location Address
First Line	:	6541 VIA DEL ORO STE B
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95119-1207
Country	:	US
Telephone Number	:	408-326-1530
Fax Number	:	408-824-1368

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	ROBIN HOKE
Credential	:	PHARM.D.
Telephone Number	:	408-292-6772

Provider Enumeration Date	:	05/09/2016
Last Update Date	:	07/19/2018

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Directions to “LEITERS ENTERPRISES INC ” Practice Location

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