Basic Information
Provider Information
NPI: 1790990596
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEUNG
FirstName: WARREN
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: RPH, PHARMD(C)
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 313 CHERRY HILL BLVD
Address2:  
City: CHERRY HILL
State: NJ
PostalCode: 080021925
CountryCode: US
TelephoneNumber: 2155195433
FaxNumber:  
Practice Location
Address1: 1601 CHERRY ST
Address2: SUITE 1700
City: PHILADELPHIA
State: PA
PostalCode: 191021321
CountryCode: US
TelephoneNumber: 2152821600
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/14/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000XRP045789LPAY Pharmacy Service ProvidersPharmacist 

No ID Information.


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