1720338650 NPI number — MR. PATRICK NELSON LEROY PHARM.D.

Table of content: MR. PATRICK NELSON LEROY PHARM.D. (NPI 1720338650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720338650 NPI number — MR. PATRICK NELSON LEROY PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEROY
Provider First Name:
PATRICK
Provider Middle Name:
NELSON
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720338650
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2110 TRUXTUN AVE
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93301-3703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-716-2673
Provider Business Mailing Address Fax Number:
661-716-2677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1017 ELLINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELANO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93215-2621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-725-9489
Provider Business Practice Location Address Fax Number:
661-725-3640
Provider Enumeration Date:
09/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  58396 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 58396 . This is a "CALIFORNIA STATE BOARD OF PHARMACY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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