Basic Information
| Provider Information | |||||||||
| NPI: | 1003146341 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEYBA | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | HUGH | ||||||||
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| Credential: | PHARM.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8363 W MOLLY LN | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853833818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024006705 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2075 W PINNACLE PEAK RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850271217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024006705 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2010 | ||||||||
| LastUpdateDate: | 01/09/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | S012813 | AZ | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.