MEDICARE: PETER LEON 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	3336C0003X	Community/Retail Pharmacy	PP412540L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3912070	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982720207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER LEON INC

Provider Business Mailing Address
First Line	:	257 N 52ND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-1502
Country	:	US
Telephone Number	:	215-747-8917
Fax Number	:	215-747-8918

Provider Business Practice Location Address
First Line	:	257 N 52ND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-1502
Country	:	US
Telephone Number	:	215-747-8917
Fax Number	:	215-747-8918

Authorized Official
Title or Position	:	OWNER AND PHARMACIST
Name	:	PETER LEON
Credential	:
Telephone Number	:	215-747-8917

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	08/11/2011

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Directions to “PETER LEON INC ” Practice Location

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